Provider Demographics
NPI:1164976304
Name:UNDER MY PILLOW PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:UNDER MY PILLOW PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:ALANA
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-244-8999
Mailing Address - Street 1:17515 SPRING CYPRESS RD
Mailing Address - Street 2:C225
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-2688
Mailing Address - Country:US
Mailing Address - Phone:832-244-8999
Mailing Address - Fax:832-202-0284
Practice Address - Street 1:9822 FRY RD
Practice Address - Street 2:SUITE 120
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-5360
Practice Address - Country:US
Practice Address - Phone:832-244-8999
Practice Address - Fax:832-202-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24315261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental