Provider Demographics
NPI:1811622707
Name:ICARE DENTAL
Entity Type:Organization
Organization Name:ICARE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CONG
Authorized Official - Middle Name:
Authorized Official - Last Name:PENG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-627-6588
Mailing Address - Street 1:3010 LEONA CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8725
Mailing Address - Country:US
Mailing Address - Phone:781-627-6588
Mailing Address - Fax:
Practice Address - Street 1:5425 HIGHWAY 6 STE C100
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4390
Practice Address - Country:US
Practice Address - Phone:281-261-8258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-24
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental