Provider Demographics
NPI:1780845016
Name:RED BIRD DENTAL, PLLC
Entity Type:Organization
Organization Name:RED BIRD DENTAL, PLLC
Other - Org Name:HOMESTEAD FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOON
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-631-3700
Mailing Address - Street 1:8300 HOMESTEAD RD
Mailing Address - Street 2:STE 3
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77028-2149
Mailing Address - Country:US
Mailing Address - Phone:713-631-3700
Mailing Address - Fax:281-888-9571
Practice Address - Street 1:8300 HOMESTEAD RD STE 3
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77028-2149
Practice Address - Country:US
Practice Address - Phone:713-631-3700
Practice Address - Fax:713-631-3703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX226411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty