Provider Demographics
NPI:1578008736
Name:FAV-ULOUS DENTAL PLLC
Entity Type:Organization
Organization Name:FAV-ULOUS DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:FABIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA DE ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-468-1400
Mailing Address - Street 1:8762 LONG POINT RD
Mailing Address - Street 2:102
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-3030
Mailing Address - Country:US
Mailing Address - Phone:713-468-1400
Mailing Address - Fax:713-468-8146
Practice Address - Street 1:8762 LONG POINT RD
Practice Address - Street 2:102
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-3030
Practice Address - Country:US
Practice Address - Phone:713-468-1400
Practice Address - Fax:713-468-8146
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAV-ULOUS DENTAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X, 1223E0200X, 1223G0001X, 1223X0400X, 124Q00000X, 126800000X
TX30122122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty