Provider Demographics
NPI:1518562792
Name:UNIVERSITY PERIODONTAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:UNIVERSITY PERIODONTAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:3100 RICHMOND AVE STE 509
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3019
Mailing Address - Country:US
Mailing Address - Phone:713-523-9040
Mailing Address - Fax:713-523-7885
Practice Address - Street 1:3100 RICHMOND AVE STE 509
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3019
Practice Address - Country:US
Practice Address - Phone:713-523-9040
Practice Address - Fax:713-523-7885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty