Provider Demographics
NPI:1346714102
Name:ATHENA DENTAL ASSOCIATES OF HOUSTON, INC.
Entity Type:Organization
Organization Name:ATHENA DENTAL ASSOCIATES OF HOUSTON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBASSI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-515-6685
Mailing Address - Street 1:2617 W HOLCOMBE BLVD STE I
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-4715
Mailing Address - Country:US
Mailing Address - Phone:832-862-1111
Mailing Address - Fax:
Practice Address - Street 1:2617 W HOLCOMBE BLVD STE I
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-4715
Practice Address - Country:US
Practice Address - Phone:832-862-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies