Provider Demographics
NPI:1811622699
Name:G.O. DENTAL CLINIC PLLC
Entity Type:Organization
Organization Name:G.O. DENTAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KWAUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-930-4005
Mailing Address - Street 1:825 TOWN AND COUNTRY LN STE 1200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2246
Mailing Address - Country:US
Mailing Address - Phone:832-930-4646
Mailing Address - Fax:832-698-9553
Practice Address - Street 1:825 TOWN AND COUNTRY LN STE 1200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2246
Practice Address - Country:US
Practice Address - Phone:832-930-4646
Practice Address - Fax:832-698-9553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty