Provider Demographics
NPI:1093948044
Name:MGMDDS
Entity Type:Organization
Organization Name:MGMDDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-486-9222
Mailing Address - Street 1:13810 JOHN AUDUBON PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-3862
Mailing Address - Country:US
Mailing Address - Phone:281-486-9222
Mailing Address - Fax:281-486-8700
Practice Address - Street 1:13810 JOHN AUDUBON PKWY STE A
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-3862
Practice Address - Country:US
Practice Address - Phone:281-486-9222
Practice Address - Fax:281-486-8700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty