Provider Demographics
NPI:1568602134
Name:SUMMIT DENTAL CENTER LP
Entity Type:Organization
Organization Name:SUMMIT DENTAL CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ESSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAWAJA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-673-0999
Mailing Address - Street 1:5225 KATY FWY STE 104
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2268
Mailing Address - Country:US
Mailing Address - Phone:832-673-0999
Mailing Address - Fax:281-657-2406
Practice Address - Street 1:4765 FM 1960 RD W STE H
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4641
Practice Address - Country:US
Practice Address - Phone:281-977-8999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17989Medicaid