Provider Demographics
NPI:1285039339
Name:KATY PERIODONTOLOGY AND ORAL SURGERY PLLC
Entity Type:Organization
Organization Name:KATY PERIODONTOLOGY AND ORAL SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:G
Authorized Official - Last Name:BACHOURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-817-4557
Mailing Address - Street 1:24437 KATY FWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-1376
Mailing Address - Country:US
Mailing Address - Phone:281-256-8400
Mailing Address - Fax:
Practice Address - Street 1:24437 KATY FWY
Practice Address - Street 2:SUITE 500
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1376
Practice Address - Country:US
Practice Address - Phone:281-256-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223P0300X
TX247871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty