Provider Demographics
NPI:1689015505
Name:SOUTH TEXAS DENTAL ASSOCIATES, LP
Entity Type:Organization
Organization Name:SOUTH TEXAS DENTAL ASSOCIATES, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-457-3445
Mailing Address - Street 1:6300 WEST LOOP S STE 650
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2997
Mailing Address - Country:US
Mailing Address - Phone:713-457-3445
Mailing Address - Fax:
Practice Address - Street 1:2482 JACKSBORO HWY
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76114-2201
Practice Address - Country:US
Practice Address - Phone:817-626-4867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX165701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty