Provider Demographics
NPI:1326647454
Name:MEMORIAL DENTISTRY FOR KIDS PLLC
Entity Type:Organization
Organization Name:MEMORIAL DENTISTRY FOR KIDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:ARYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-253-9970
Mailing Address - Street 1:14090 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-6848
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14090 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-6848
Practice Address - Country:US
Practice Address - Phone:713-714-1244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty