Provider Demographics
NPI:1326222530
Name:MOTA DENTAL PC
Entity Type:Organization
Organization Name:MOTA DENTAL PC
Other - Org Name:ALPHA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISELSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-274-9065
Mailing Address - Street 1:550 KATY FORT BEND RD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494
Mailing Address - Country:US
Mailing Address - Phone:281-574-2460
Mailing Address - Fax:281-574-2466
Practice Address - Street 1:550 KATY FORT BEND RD
Practice Address - Street 2:SUITE #100
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494
Practice Address - Country:US
Practice Address - Phone:281-574-2460
Practice Address - Fax:281-574-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty