Provider Demographics
NPI:1689027567
Name:CHI FAMILY DENTAL
Entity Type:Organization
Organization Name:CHI FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHI
Authorized Official - Middle Name:AGNES
Authorized Official - Last Name:MBA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-213-2658
Mailing Address - Street 1:8731 HWY 6
Mailing Address - Street 2:STE 300
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459
Mailing Address - Country:US
Mailing Address - Phone:713-213-2658
Mailing Address - Fax:866-892-0774
Practice Address - Street 1:8731 HWY 6
Practice Address - Street 2:STE 300
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459
Practice Address - Country:US
Practice Address - Phone:713-213-2658
Practice Address - Fax:866-892-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX309511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1760864797OtherNPI TYPE 1