Provider Demographics
NPI:1184816373
Name:MISSION DENTISTRY GROUP
Entity Type:Organization
Organization Name:MISSION DENTISTRY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-554-0453
Mailing Address - Street 1:6440 HILLCROFT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-3192
Mailing Address - Country:US
Mailing Address - Phone:713-554-0453
Mailing Address - Fax:713-554-0456
Practice Address - Street 1:6440 HILLCROFT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-3192
Practice Address - Country:US
Practice Address - Phone:713-554-0453
Practice Address - Fax:713-554-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX190921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty