Provider Demographics
NPI:1508261090
Name:GOLDEN EAGLE DENTAL PLLC
Entity Type:Organization
Organization Name:GOLDEN EAGLE DENTAL PLLC
Other - Org Name:BAYTOWN GENTLE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-837-9122
Mailing Address - Street 1:3451 RIVER PARK DR
Mailing Address - Street 2:#2224
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-9587
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3700 EMMETT HUTTO BLVD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-1764
Practice Address - Country:US
Practice Address - Phone:281-837-9122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty