Provider Demographics
NPI:1720206121
Name:SOUTH TEXAS DENTAL ASSOCIATES, L.P.
Entity Type:Organization
Organization Name:SOUTH TEXAS DENTAL ASSOCIATES, L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GOMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-663-7960
Mailing Address - Street 1:6300 WEST LOOP S STE 650
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2997
Mailing Address - Country:US
Mailing Address - Phone:713-663-7960
Mailing Address - Fax:713-349-8027
Practice Address - Street 1:3200 S LANCASTER RD STE 760
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-8823
Practice Address - Country:US
Practice Address - Phone:214-375-4100
Practice Address - Fax:214-375-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX165701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty