Provider Demographics
NPI:1003443284
Name:TRINITY SPRING DENTAL PLLC
Entity Type:Organization
Organization Name:TRINITY SPRING DENTAL PLLC
Other - Org Name:TRINITY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:832-648-7632
Mailing Address - Street 1:507 N SAM HOUSTON PKWY E STE 565
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-4021
Mailing Address - Country:US
Mailing Address - Phone:832-648-7632
Mailing Address - Fax:
Practice Address - Street 1:5240 FM 2920 RD STE 400
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3003
Practice Address - Country:US
Practice Address - Phone:832-648-7632
Practice Address - Fax:832-532-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty