Provider Demographics
NPI:1790349165
Name:ENDODONTICS & MICROSURGERY CENTER PC
Entity Type:Organization
Organization Name:ENDODONTICS & MICROSURGERY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/ENDODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:MENDEZ MONTALVO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-655-8445
Mailing Address - Street 1:23543 KINGSLAND BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3962
Mailing Address - Country:US
Mailing Address - Phone:281-655-8445
Mailing Address - Fax:346-257-4962
Practice Address - Street 1:23543 KINGSLAND BLVD STE 500
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3962
Practice Address - Country:US
Practice Address - Phone:281-655-8445
Practice Address - Fax:346-257-4962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX25824OtherTEXAS DENTAL LICENSE NUMBER