Provider Demographics
NPI:1497132328
Name:ESGB, INC
Entity Type:Organization
Organization Name:ESGB, INC
Other - Org Name:WOODFOREST PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:713-703-0737
Mailing Address - Street 1:514 HONEA EGYPT RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-3399
Mailing Address - Country:US
Mailing Address - Phone:713-703-0737
Mailing Address - Fax:
Practice Address - Street 1:514 HONEA EGYPT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-3399
Practice Address - Country:US
Practice Address - Phone:713-703-0737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX244811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty