Provider Demographics
NPI:1467432575
Name:FOUAT BEND DENTAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:FOUAT BEND DENTAL ASSOCIATES, PLLC
Other - Org Name:FORT BEND DENTAL ASSOCIATES, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR/MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:D
Authorized Official - Last Name:PECCORA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-499-3541
Mailing Address - Street 1:3717 TOWNSHIP LANE
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459
Mailing Address - Country:US
Mailing Address - Phone:281-499-3541
Mailing Address - Fax:281-499-3533
Practice Address - Street 1:3717 TOWNSHIP LANE
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459
Practice Address - Country:US
Practice Address - Phone:281-499-3541
Practice Address - Fax:281-605-5956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty