Provider Demographics
NPI:1043729783
Name:GHAIDAA DENTAL PLLC
Entity Type:Organization
Organization Name:GHAIDAA DENTAL PLLC
Other - Org Name:HYATT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRACIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-232-5353
Mailing Address - Street 1:13442 BELLAIRE BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-2641
Mailing Address - Country:US
Mailing Address - Phone:832-232-5353
Mailing Address - Fax:832-225-8500
Practice Address - Street 1:13442 BELLAIRE SUITE D
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083
Practice Address - Country:US
Practice Address - Phone:832-232-5353
Practice Address - Fax:832-225-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental