Provider Demographics
NPI:1386867752
Name:PEDIATRIC DENTAL WELLNESS
Entity Type:Organization
Organization Name:PEDIATRIC DENTAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:RALPH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:281-495-3343
Mailing Address - Street 1:11921 BISSONNET ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-1425
Mailing Address - Country:US
Mailing Address - Phone:281-495-3343
Mailing Address - Fax:281-495-1125
Practice Address - Street 1:11921 BISSONNET ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-1425
Practice Address - Country:US
Practice Address - Phone:281-495-3343
Practice Address - Fax:281-495-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty