Provider Demographics
NPI:1578953766
Name:MARINA DENTAL PLLC
Entity Type:Organization
Organization Name:MARINA DENTAL PLLC
Other - Org Name:MI HOGAR DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:EPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-203-7968
Mailing Address - Street 1:900 S WAYSIDE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-3427
Mailing Address - Country:US
Mailing Address - Phone:281-974-3996
Mailing Address - Fax:
Practice Address - Street 1:5406 AIRLINE DR
Practice Address - Street 2:SUITE F
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4948
Practice Address - Country:US
Practice Address - Phone:281-905-6660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty