Provider Demographics
NPI:1568742641
Name:JEFF TOLLETT DDS PA
Entity Type:Organization
Organization Name:JEFF TOLLETT DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:TOLLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-622-3240
Mailing Address - Street 1:1011 AUGUSTA DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-2062
Mailing Address - Country:US
Mailing Address - Phone:713-622-3240
Mailing Address - Fax:713-622-3280
Practice Address - Street 1:7515 MAIN ST
Practice Address - Street 2:SUITE 710
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4519
Practice Address - Country:US
Practice Address - Phone:713-795-5951
Practice Address - Fax:713-795-5794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27023261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental