Provider Demographics
NPI:1851732093
Name:HOUSTONIAN DENTAL SW, P.A.
Entity Type:Organization
Organization Name:HOUSTONIAN DENTAL SW, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TELEMANTEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-777-7778
Mailing Address - Street 1:8535 WEST BELLFORT AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-2264
Mailing Address - Country:US
Mailing Address - Phone:713-777-7778
Mailing Address - Fax:713-988-2422
Practice Address - Street 1:8535 WEST BELLFORT AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-2264
Practice Address - Country:US
Practice Address - Phone:713-777-7778
Practice Address - Fax:713-988-2422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX323014601Medicaid