Provider Demographics
NPI:1093256190
Name:TEXAS DENTAL ASSOCIATES PA
Entity Type:Organization
Organization Name:TEXAS DENTAL ASSOCIATES PA
Other - Org Name:SPLENDID DENTAL CARE AND MY CHILDREN'S DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAHARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LESAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-490-8880
Mailing Address - Street 1:2536 AMHERST ST STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-3207
Mailing Address - Country:US
Mailing Address - Phone:713-490-8880
Mailing Address - Fax:
Practice Address - Street 1:3991 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5803
Practice Address - Country:US
Practice Address - Phone:713-244-7797
Practice Address - Fax:281-888-9653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
TX66261223G0001X, 1223P0221X, 1223P0300X, 1223S0112X, 1223X0400X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty