Provider Demographics
NPI:1437870664
Name:KONTI, POLYXENI
Entity Type:Individual
Prefix:
First Name:POLYXENI
Middle Name:
Last Name:KONTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 BUSINESS CENTER DR APT 625
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2431
Mailing Address - Country:US
Mailing Address - Phone:475-266-1657
Mailing Address - Fax:
Practice Address - Street 1:12626 WOODFOREST BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-3642
Practice Address - Country:US
Practice Address - Phone:713-590-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39002122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist