Provider Demographics
NPI:1235754714
Name:SILVERSTONE DENTAL GROUP
Entity Type:Organization
Organization Name:SILVERSTONE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ORIEJI
Authorized Official - Middle Name:
Authorized Official - Last Name:ODINIGWE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-449-6627
Mailing Address - Street 1:10615 DAVLEE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-4328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20400 SOUTHWEST FWY STE 105
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-7112
Practice Address - Country:US
Practice Address - Phone:832-449-6627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX338650006Medicaid