Provider Demographics
NPI:1760056741
Name:I-10 DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:I-10 DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRDISLAND
Authorized Official - Middle Name:C
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-498-9865
Mailing Address - Street 1:16006 SONOMA PARK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049-1080
Mailing Address - Country:US
Mailing Address - Phone:832-498-9865
Mailing Address - Fax:
Practice Address - Street 1:13319 EAST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-5801
Practice Address - Country:US
Practice Address - Phone:713-451-3333
Practice Address - Fax:713-451-3394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty