Provider Demographics
NPI:1790417111
Name:GH RADFORD DDS & ASSOC., INC
Entity Type:Organization
Organization Name:GH RADFORD DDS & ASSOC., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-291-3474
Mailing Address - Street 1:3216 OAKMONT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-1131
Mailing Address - Country:US
Mailing Address - Phone:832-723-5052
Mailing Address - Fax:
Practice Address - Street 1:9330 BROADWAY ST STE 320B
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7895
Practice Address - Country:US
Practice Address - Phone:713-340-0625
Practice Address - Fax:713-340-1881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty