Provider Demographics
NPI:1194454520
Name:SLC DENTAL, PLLC
Entity Type:Organization
Organization Name:SLC DENTAL, PLLC
Other - Org Name:NU DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-930-7748
Mailing Address - Street 1:3201 N SHEPHERD DR
Mailing Address - Street 2:SUITE 113
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3201 N SHEPHERD DR
Practice Address - Street 2:SUITE 113
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018
Practice Address - Country:US
Practice Address - Phone:832-916-4144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3851792Medicaid