Provider Demographics
NPI:1104865013
Name:THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON
Entity Type:Organization
Organization Name:THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON
Other - Org Name:UT PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PATIENT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIEU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-486-4242
Mailing Address - Street 1:7500 CAMBRIDGE ST # 3410
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2032
Mailing Address - Country:US
Mailing Address - Phone:713-500-8220
Mailing Address - Fax:712-500-8210
Practice Address - Street 1:7500 CAMBRIDGE ST STE 3410
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2032
Practice Address - Country:US
Practice Address - Phone:713-500-8220
Practice Address - Fax:712-500-8210
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-06
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009733901Medicaid