Provider Demographics
NPI:1477171973
Name:TELEDENTIST365 FOUNDATION
Entity Type:Organization
Organization Name:TELEDENTIST365 FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:IMO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-758-6885
Mailing Address - Street 1:133 N FRIENDSWOOD DR STE 187
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3746
Mailing Address - Country:US
Mailing Address - Phone:301-758-6885
Mailing Address - Fax:
Practice Address - Street 1:2111 LIMRICK DRIVE
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581
Practice Address - Country:US
Practice Address - Phone:301-758-6885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare