Provider Demographics
NPI:1053668137
Name:C.C. TREJO D.D.S., P.A.
Entity Type:Organization
Organization Name:C.C. TREJO D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORLETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:TREJO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-785-4867
Mailing Address - Street 1:2600 S GESSNER RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-3200
Mailing Address - Country:US
Mailing Address - Phone:713-785-4867
Mailing Address - Fax:713-785-1191
Practice Address - Street 1:2600 S GESSNER RD
Practice Address - Street 2:SUITE 304
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-3200
Practice Address - Country:US
Practice Address - Phone:713-785-4867
Practice Address - Fax:713-785-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179541223G0001X
TX190951223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty