Provider Demographics
NPI:1821529967
Name:GE DENTAL
Entity Type:Organization
Organization Name:GE DENTAL
Other - Org Name:FAIRLAKES FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GHATTAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-973-2844
Mailing Address - Street 1:15103 MASON RD
Mailing Address - Street 2:SUITE B-8
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433
Mailing Address - Country:US
Mailing Address - Phone:281-973-2844
Mailing Address - Fax:281-213-4598
Practice Address - Street 1:15103 MASON RD
Practice Address - Street 2:SUITE B-8
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433
Practice Address - Country:US
Practice Address - Phone:281-973-2844
Practice Address - Fax:281-213-4598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
226211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty