Provider Demographics
NPI:1356076129
Name:GLA DENTAL PLLC
Entity Type:Organization
Organization Name:GLA DENTAL PLLC
Other - Org Name:NU DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-930-7748
Mailing Address - Street 1:8940 BARKER CYPRESS RD STE 170
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-8905
Mailing Address - Country:US
Mailing Address - Phone:832-930-7746
Mailing Address - Fax:
Practice Address - Street 1:8940 BARKER CYPRESS RD STE 170
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-8905
Practice Address - Country:US
Practice Address - Phone:832-930-7746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3851792Medicaid