Provider Demographics
NPI:1609865070
Name:GEORGE, REENA THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:REENA
Middle Name:THOMAS
Last Name:GEORGE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 CRESCENT PLAZA DR
Mailing Address - Street 2:APT #1169
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-2476
Mailing Address - Country:US
Mailing Address - Phone:512-535-5747
Mailing Address - Fax:
Practice Address - Street 1:12626 WOODFOREST BLVD
Practice Address - Street 2:#Z
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-3425
Practice Address - Country:US
Practice Address - Phone:713-590-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025741122300000X
TX23742122300000X, 1223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL163346Medicaid