Provider Demographics
NPI:1003686148
Name:LIFELINE DENTAL PLLC
Entity Type:Organization
Organization Name:LIFELINE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AYHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NAHHAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-459-8782
Mailing Address - Street 1:1147 CLEAR LAKE CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-8102
Mailing Address - Country:US
Mailing Address - Phone:281-409-3777
Mailing Address - Fax:
Practice Address - Street 1:1147 CLEAR LAKE CITY BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-8102
Practice Address - Country:US
Practice Address - Phone:281-409-3777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty