Provider Demographics
NPI:1619297603
Name:MEDICAL CENTER ENDODONTICS
Entity Type:Organization
Organization Name:MEDICAL CENTER ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:
Authorized Official - Last Name:GARALA
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, MS
Authorized Official - Phone:713-795-0208
Mailing Address - Street 1:7515 MAIN ST STE 610
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4515
Mailing Address - Country:US
Mailing Address - Phone:713-795-0208
Mailing Address - Fax:
Practice Address - Street 1:7515 MAIN ST STE 610
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4515
Practice Address - Country:US
Practice Address - Phone:713-795-0208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210791223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty