Provider Demographics
NPI:1093092355
Name:PANTHER CREEK FAMILY DENTISTRY
Entity Type:Organization
Organization Name:PANTHER CREEK FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:K
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-419-2405
Mailing Address - Street 1:4775 W PANTHER CREEK DR
Mailing Address - Street 2:SUITE B265
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-3592
Mailing Address - Country:US
Mailing Address - Phone:281-419-2405
Mailing Address - Fax:281-419-2407
Practice Address - Street 1:4775 W PANTHER CREEK DR
Practice Address - Street 2:SUITE B265
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-3592
Practice Address - Country:US
Practice Address - Phone:281-419-2405
Practice Address - Fax:281-419-2407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX222921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty