Provider Demographics
NPI:1891328761
Name:FOX CREEK ENDODONTICS
Entity Type:Organization
Organization Name:FOX CREEK ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:GUADALUPE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-756-1676
Mailing Address - Street 1:2040 N LOOP 336 W STE 300
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3579
Mailing Address - Country:US
Mailing Address - Phone:936-756-1676
Mailing Address - Fax:936-756-1675
Practice Address - Street 1:2040 N LOOP 336 W STE 300
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3579
Practice Address - Country:US
Practice Address - Phone:936-756-1676
Practice Address - Fax:936-756-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1891046090OtherNPI