Provider Demographics
NPI:1649419383
Name:ROSITA HAMIDI DENTAL PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ROSITA HAMIDI DENTAL PROFESSIONAL CORPORATION
Other - Org Name:SMILE TIME DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSITA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-733-3381
Mailing Address - Street 1:12625 MEMORIAL DR
Mailing Address - Street 2:UNIT 161
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4889
Mailing Address - Country:US
Mailing Address - Phone:281-733-3381
Mailing Address - Fax:281-245-0725
Practice Address - Street 1:12625 MEMORIAL DR
Practice Address - Street 2:UNIT 161
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-4889
Practice Address - Country:US
Practice Address - Phone:281-733-3381
Practice Address - Fax:281-245-0725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX240751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty