Provider Demographics
NPI:1083223960
Name:AVILAB DENTAL SERVICES LLC
Entity Type:Organization
Organization Name:AVILAB DENTAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-381-0861
Mailing Address - Street 1:6407 GREENCREEK MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-8243
Mailing Address - Country:US
Mailing Address - Phone:832-381-0861
Mailing Address - Fax:
Practice Address - Street 1:5115 BUFFALO SPEEDWAY STE 700
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-4213
Practice Address - Country:US
Practice Address - Phone:832-381-0861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory