Provider Demographics
NPI:1174033054
Name:DD CITYCENTRE HOLDINGS PLLC
Entity Type:Organization
Organization Name:DD CITYCENTRE HOLDINGS PLLC
Other - Org Name:URBN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-714-4245
Mailing Address - Street 1:2400 MID LN STE 350
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-4466
Mailing Address - Country:US
Mailing Address - Phone:713-714-4245
Mailing Address - Fax:
Practice Address - Street 1:2400 MID LN STE 350
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-4466
Practice Address - Country:US
Practice Address - Phone:713-714-4245
Practice Address - Fax:713-714-4245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX303981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty