Provider Demographics
NPI:1720599251
Name:WALK IN DENTAL CLINIC OF KATY
Entity Type:Organization
Organization Name:WALK IN DENTAL CLINIC OF KATY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEENISH
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-338-7825
Mailing Address - Street 1:20919 KINGSLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5548
Mailing Address - Country:US
Mailing Address - Phone:713-999-5328
Mailing Address - Fax:
Practice Address - Street 1:20919 KINGSLAND BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5548
Practice Address - Country:US
Practice Address - Phone:713-999-5328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32473122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty