Provider Demographics
NPI:1770639395
Name:AMERICAN ABC DENTAL,PLLC
Entity Type:Organization
Organization Name:AMERICAN ABC DENTAL,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:VILLARROEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-910-4644
Mailing Address - Street 1:914 EDGEBROOK DR
Mailing Address - Street 2:B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-1955
Mailing Address - Country:US
Mailing Address - Phone:713-910-4644
Mailing Address - Fax:713-910-4697
Practice Address - Street 1:914 EDGEBROOK DR
Practice Address - Street 2:B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-1955
Practice Address - Country:US
Practice Address - Phone:713-910-4644
Practice Address - Fax:713-910-4697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX187111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090710702Medicare ID - Type Unspecified
TX=========Medicare UPIN