Provider Demographics
NPI:1114438942
Name:AMITA DAMANI DDS, PA
Entity Type:Organization
Organization Name:AMITA DAMANI DDS, PA
Other - Org Name:PEDIATRIC DENTAL SAFARI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-203-8577
Mailing Address - Street 1:947 GESSNER RD STE A240
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1729
Mailing Address - Country:US
Mailing Address - Phone:832-203-8577
Mailing Address - Fax:281-929-0813
Practice Address - Street 1:947 GESSNER RD STE A240
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1729
Practice Address - Country:US
Practice Address - Phone:832-203-8577
Practice Address - Fax:281-929-0813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247881223P0221X
TX252571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1134443468Medicaid