Provider Demographics
NPI:1609231372
Name:FORT BEND DENTAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:FORT BEND DENTAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST - PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:PECCORA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-499-3541
Mailing Address - Street 1:5819 HIGHWAY 6 STE 230
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4070
Mailing Address - Country:US
Mailing Address - Phone:281-499-3541
Mailing Address - Fax:
Practice Address - Street 1:5819 HIGHWAY 6 STE 230
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4070
Practice Address - Country:US
Practice Address - Phone:281-499-3541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DDS PARTNERS HOLDINGS LLLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25645122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty