Provider Demographics
NPI:1528544988
Name:TRINIDAD FAMILY DENTAL PLLC
Entity Type:Organization
Organization Name:TRINIDAD FAMILY DENTAL PLLC
Other - Org Name:MIRAMAR FAMILY DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KEYTTIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEOVIDES BONACHEA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:832-779-8444
Mailing Address - Street 1:6127 N FRY RD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-5563
Mailing Address - Country:US
Mailing Address - Phone:832-779-8444
Mailing Address - Fax:
Practice Address - Street 1:6127 N FRY RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-5563
Practice Address - Country:US
Practice Address - Phone:832-779-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty