Provider Demographics
NPI:1194188128
Name:BEARCREEK DENTISTRY & ORTHODONTICS
Entity Type:Organization
Organization Name:BEARCREEK DENTISTRY & ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-855-9665
Mailing Address - Street 1:4303 HIGHWAY 6 N
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-3446
Mailing Address - Country:US
Mailing Address - Phone:281-855-9665
Mailing Address - Fax:
Practice Address - Street 1:4303 HIGHWAY 6 N
Practice Address - Street 2:SUITE A-1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-3446
Practice Address - Country:US
Practice Address - Phone:281-855-9665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty