Provider Demographics
NPI:1497130843
Name:TEXAS FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:TEXAS FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-465-8239
Mailing Address - Street 1:1919 LAKE WINDS DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1710
Mailing Address - Country:US
Mailing Address - Phone:832-433-7252
Mailing Address - Fax:
Practice Address - Street 1:910 S WAYSIDE DR STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-3417
Practice Address - Country:US
Practice Address - Phone:832-433-7252
Practice Address - Fax:832-668-5447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX23077OtherLICENSE NUMBER