Provider Demographics
NPI:1164912838
Name:HOUSTON SOUTH EDC MANAGEMENT LLC
Entity Type:Organization
Organization Name:HOUSTON SOUTH EDC MANAGEMENT LLC
Other - Org Name:EMERGENCY DENTAL CARE USA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OBENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-393-2726
Mailing Address - Street 1:4245 S 143RD CIR STE 7
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-4519
Mailing Address - Country:US
Mailing Address - Phone:402-393-2726
Mailing Address - Fax:402-393-2886
Practice Address - Street 1:7906 GULF FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-3018
Practice Address - Country:US
Practice Address - Phone:713-396-3844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty