Provider Demographics
NPI:1235994864
Name:SUGAR LAND PERIOCOSMETIC DENTAL PLLC
Entity Type:Organization
Organization Name:SUGAR LAND PERIOCOSMETIC DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZHIJIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:832-620-9131
Mailing Address - Street 1:PO BOX 17029
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-7029
Mailing Address - Country:US
Mailing Address - Phone:832-620-9131
Mailing Address - Fax:
Practice Address - Street 1:2941 BROADWAY BEND DR STE 206
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2291
Practice Address - Country:US
Practice Address - Phone:832-620-9131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22372OtherDENTAL LICENSE