Provider Demographics
NPI:1568626422
Name:PARKWAY DENTAL GROUP
Entity Type:Organization
Organization Name:PARKWAY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-485-2231
Mailing Address - Street 1:2800 BROADWAY ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-9502
Mailing Address - Country:US
Mailing Address - Phone:281-485-2231
Mailing Address - Fax:281-485-2290
Practice Address - Street 1:2800 BROADWAY ST
Practice Address - Street 2:SUITE I
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-9502
Practice Address - Country:US
Practice Address - Phone:281-485-2231
Practice Address - Fax:281-485-2290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111077701Medicaid