Provider Demographics
NPI:1790186930
Name:NAVASOTA DENTAL, PC
Entity Type:Organization
Organization Name:NAVASOTA DENTAL, PC
Other - Org Name:NAVASOTA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSHMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:RATH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-799-5317
Mailing Address - Street 1:415 NORTH LASALLE STREET
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NAVASOTA
Mailing Address - State:TX
Mailing Address - Zip Code:77868
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 NORTH LASALLE STREET
Practice Address - Street 2:SUITE 1A
Practice Address - City:NAVASOTA
Practice Address - State:TX
Practice Address - Zip Code:77868
Practice Address - Country:US
Practice Address - Phone:479-799-5317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX293151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty