Provider Demographics
NPI:1437340478
Name:THE HOUSTON DENTAL GROUP INC
Entity Type:Organization
Organization Name:THE HOUSTON DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-292-8499
Mailing Address - Street 1:22901 MILLCREEK BLVD
Mailing Address - Street 2:STE. 140
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5728
Mailing Address - Country:US
Mailing Address - Phone:216-292-8499
Mailing Address - Fax:216-292-8745
Practice Address - Street 1:22901 MILLCREEK BLVD
Practice Address - Street 2:STE. 140
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5728
Practice Address - Country:US
Practice Address - Phone:216-292-8499
Practice Address - Fax:216-292-8745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH138011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0195319Medicaid