Provider Demographics
NPI:1073021424
Name:TRINITY DENTAL MANAGEMENT GROUP
Entity Type:Organization
Organization Name:TRINITY DENTAL MANAGEMENT GROUP
Other - Org Name:BLUEBONNET DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NADER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-788-2727
Mailing Address - Street 1:2600 S GESSNER RD STE 414
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-3294
Mailing Address - Country:US
Mailing Address - Phone:281-501-9371
Mailing Address - Fax:
Practice Address - Street 1:2600 S GESSNER RD STE 414
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-3294
Practice Address - Country:US
Practice Address - Phone:281-501-9371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty