Provider Demographics
NPI:1114143104
Name:SAGULLO, MARY ANN GRACE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:GRACE
Last Name:SAGULLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22235 RUSSELL DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW CANEY
Mailing Address - State:TX
Mailing Address - Zip Code:77357
Mailing Address - Country:US
Mailing Address - Phone:281-689-1760
Mailing Address - Fax:
Practice Address - Street 1:1445 N LOOP WEST
Practice Address - Street 2:SUITE 1000
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008
Practice Address - Country:US
Practice Address - Phone:713-861-3231
Practice Address - Fax:713-426-1720
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist