Provider Demographics
NPI:1750634499
Name:DESIGN DENTAL GROUP II PLLC
Entity Type:Organization
Organization Name:DESIGN DENTAL GROUP II PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BIBB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-365-0334
Mailing Address - Street 1:4500 WASHINGTON AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007
Mailing Address - Country:US
Mailing Address - Phone:713-869-0334
Mailing Address - Fax:713-869-0339
Practice Address - Street 1:9738 KATY FREEWAY
Practice Address - Street 2:SUITE 400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055
Practice Address - Country:US
Practice Address - Phone:713-365-0334
Practice Address - Fax:713-973-2251
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESIGN DENTAL GROUP PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22708261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180590512Medicaid