Provider Demographics
NPI:1487849733
Name:NOVA DENTAL CARE, PC
Entity Type:Organization
Organization Name:NOVA DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HSIEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-690-2555
Mailing Address - Street 1:7758 W TIDWELL RD
Mailing Address - Street 2:STE#126
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-5741
Mailing Address - Country:US
Mailing Address - Phone:713-690-2555
Mailing Address - Fax:713-690-2777
Practice Address - Street 1:7758 W TIDWELL RD
Practice Address - Street 2:STE#126
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-5741
Practice Address - Country:US
Practice Address - Phone:713-690-2555
Practice Address - Fax:713-690-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG60473-01OtherTX CHIP