Provider Demographics
NPI:1003964214
Name:ARCHANGEL DENTAL GROUP, P.A.
Entity Type:Organization
Organization Name:ARCHANGEL DENTAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:KAI
Authorized Official - Last Name:CHOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-879-5800
Mailing Address - Street 1:10100 BEECHNUT ST STE 110
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-5042
Mailing Address - Country:US
Mailing Address - Phone:281-879-5800
Mailing Address - Fax:281-879-5858
Practice Address - Street 1:10100 BEECHNUT ST
Practice Address - Street 2:SUITE 110
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-5000
Practice Address - Country:US
Practice Address - Phone:281-879-5800
Practice Address - Fax:281-879-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-07
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159127301Medicaid