Provider Demographics
NPI:1689166415
Name:FOUNDATION ENDODONTICS PLLC
Entity Type:Organization
Organization Name:FOUNDATION ENDODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZK
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, MSD
Authorized Official - Phone:713-805-7080
Mailing Address - Street 1:3255 LAS PALMAS ST APT 545
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5779
Mailing Address - Country:US
Mailing Address - Phone:713-805-7080
Mailing Address - Fax:
Practice Address - Street 1:7830 W GRAND PKWY S STE 295
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5816
Practice Address - Country:US
Practice Address - Phone:281-961-0961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324111223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1821497470OtherNPI