Provider Demographics
NPI:1851641476
Name:LA MICHOACANA DENTAL CLINIC#3 LLC
Entity Type:Organization
Organization Name:LA MICHOACANA DENTAL CLINIC#3 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADELINA
Authorized Official - Middle Name:PABLOS
Authorized Official - Last Name:MONTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-691-1188
Mailing Address - Street 1:6333 BARKER CYPRESS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-1625
Mailing Address - Country:US
Mailing Address - Phone:713-691-1188
Mailing Address - Fax:713-691-1196
Practice Address - Street 1:6333 BARKER CYPRESS RD
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-1625
Practice Address - Country:US
Practice Address - Phone:713-691-1188
Practice Address - Fax:713-691-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18185261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126781986Medicaid