Provider Demographics
NPI:1710239116
Name:TOWN AND COUNTRY ORTHODONTICS
Entity Type:Organization
Organization Name:TOWN AND COUNTRY ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-465-3400
Mailing Address - Street 1:788 W SAM HOUSTON PKWY N
Mailing Address - Street 2:SUITE #201
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-3974
Mailing Address - Country:US
Mailing Address - Phone:713-465-3400
Mailing Address - Fax:713-465-3401
Practice Address - Street 1:788 W SAM HOUSTON PKWY N
Practice Address - Street 2:SUITE #201
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-3974
Practice Address - Country:US
Practice Address - Phone:713-465-3400
Practice Address - Fax:713-465-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23517261QD0000X
TX22867261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental