Provider Demographics
NPI:1841572401
Name:LETRA, ARIADNE M (DDS,MS,PHD)
Entity Type:Individual
Prefix:
First Name:ARIADNE
Middle Name:M
Last Name:LETRA
Suffix:
Gender:F
Credentials:DDS,MS,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 SHADY COVE CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-1340
Mailing Address - Country:US
Mailing Address - Phone:281-968-2009
Mailing Address - Fax:
Practice Address - Street 1:6516 M D ANDERSON BLVD RM 202
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3402
Practice Address - Country:US
Practice Address - Phone:713-500-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX274591223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics