Provider Demographics
NPI:1104030410
Name:AMIGO DENTAL, DDS, PA
Entity Type:Organization
Organization Name:AMIGO DENTAL, DDS, PA
Other - Org Name:BARKER CYPRESS DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAM
Authorized Official - Middle Name:CHI
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-690-8585
Mailing Address - Street 1:10245 KEMPWOOD DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-1803
Mailing Address - Country:US
Mailing Address - Phone:713-690-8585
Mailing Address - Fax:713-690-8586
Practice Address - Street 1:10245 KEMPWOOD DR
Practice Address - Street 2:SUITE C
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-1803
Practice Address - Country:US
Practice Address - Phone:713-690-8585
Practice Address - Fax:713-690-8586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX190041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty