Provider Demographics
NPI:1689868028
Name:CORINA DIA-BAJSEL D.D.S.PC
Entity Type:Organization
Organization Name:CORINA DIA-BAJSEL D.D.S.PC
Other - Org Name:TEXAS DENTAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ-BAJSEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-926-8899
Mailing Address - Street 1:5616 LAWNDALE BLVD.
Mailing Address - Street 2:A-204
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-2700
Mailing Address - Country:US
Mailing Address - Phone:713-926-8899
Mailing Address - Fax:713-923-7000
Practice Address - Street 1:5616 LAWNDALE BLDV.
Practice Address - Street 2:A-204
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-2700
Practice Address - Country:US
Practice Address - Phone:713-296-8899
Practice Address - Fax:173-923-7000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX147451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty