Provider Demographics
NPI:1760903439
Name:WEERA FAMILY DENTISTRY, PLLC
Entity Type:Organization
Organization Name:WEERA FAMILY DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SURACHON
Authorized Official - Middle Name:
Authorized Official - Last Name:WEERACHARTKUL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-392-1993
Mailing Address - Street 1:6001 HILLCROFT AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081
Mailing Address - Country:US
Mailing Address - Phone:713-392-1993
Mailing Address - Fax:
Practice Address - Street 1:6001 HILLCROFT ST STE 600
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-1016
Practice Address - Country:US
Practice Address - Phone:713-392-1993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24536122300000X, 261QD0000X
TX24263261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1447489463Medicaid
TX1881843241Medicaid