Provider Demographics
NPI:1750835526
Name:MORCOS, MARY FATHY FAWZY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:FATHY FAWZY
Last Name:MORCOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 LAS PALMAS ST
Mailing Address - Street 2:APT 510
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5767
Mailing Address - Country:US
Mailing Address - Phone:646-662-1228
Mailing Address - Fax:
Practice Address - Street 1:1632 SPENCER HWY
Practice Address - Street 2:
Practice Address - City:SOUTH HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77587-3752
Practice Address - Country:US
Practice Address - Phone:713-910-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32326122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist