Provider Demographics
NPI:1689684417
Name:LEON XAVIER FOREMAN DDS, PLLC
Entity Type:Organization
Organization Name:LEON XAVIER FOREMAN DDS, PLLC
Other - Org Name:ICON DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEON
Authorized Official - Middle Name:
Authorized Official - Last Name:FOREMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-266-2929
Mailing Address - Street 1:6776 SOUTHWEST FREEWAY
Mailing Address - Street 2:SUITE 252
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074
Mailing Address - Country:US
Mailing Address - Phone:713-266-2929
Mailing Address - Fax:713-266-4602
Practice Address - Street 1:6776 SOUTHWEST FREEWAY
Practice Address - Street 2:SUITE 252
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074
Practice Address - Country:US
Practice Address - Phone:713-266-2929
Practice Address - Fax:713-266-4602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210951223G0001X
TX215211223G0001X, 261QD0000X
TX235891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty