Provider Demographics
NPI:1821538810
Name:ADVANCED PERIODONTICS AND IMPLANTS OF KATY
Entity Type:Organization
Organization Name:ADVANCED PERIODONTICS AND IMPLANTS OF KATY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:409-718-7857
Mailing Address - Street 1:25318 KINGSLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-0000
Mailing Address - Country:US
Mailing Address - Phone:832-840-9560
Mailing Address - Fax:
Practice Address - Street 1:25318 KINGSLAND BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-0000
Practice Address - Country:US
Practice Address - Phone:832-840-9560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29300261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental