Provider Demographics
NPI:1922280114
Name:THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON
Entity Type:Organization
Organization Name:THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON
Other - Org Name:UT HOUSTON ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIR, PROFESSOR, ADV EDU PROG DIR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-486-4227
Mailing Address - Street 1:7500 CAMBRIDGE SUITE 6400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054
Mailing Address - Country:US
Mailing Address - Phone:713-486-4112
Mailing Address - Fax:713-486-0402
Practice Address - Street 1:7500 CAMBRIDGE SUITE 1462
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054
Practice Address - Country:US
Practice Address - Phone:713-486-4230
Practice Address - Fax:713-486-0845
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-29
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009886501Medicaid