Provider Demographics
NPI:1437473154
Name:CEJ DENTAL CENTER LLC
Entity Type:Organization
Organization Name:CEJ DENTAL CENTER LLC
Other - Org Name:CEJ DENTAL CENTER LLC DBA PERLA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-983-5200
Mailing Address - Street 1:11595 WILCREST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099
Mailing Address - Country:US
Mailing Address - Phone:281-983-5200
Mailing Address - Fax:281-983-5204
Practice Address - Street 1:11595 WILCREST
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099
Practice Address - Country:US
Practice Address - Phone:281-983-5200
Practice Address - Fax:281-983-5204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21866122300000X
TX23443122300000X
TX23417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty