Provider Demographics
NPI:1952661308
Name:ANGELA DENTAL CENTER, P.L.L.C
Entity Type:Organization
Organization Name:ANGELA DENTAL CENTER, P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSYEH
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:TAVAKKOLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-877-0962
Mailing Address - Street 1:4006 SAND MYRTLE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-3028
Mailing Address - Country:US
Mailing Address - Phone:832-877-0962
Mailing Address - Fax:
Practice Address - Street 1:6906 AIRLINE DR STE 106
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-2455
Practice Address - Country:US
Practice Address - Phone:713-691-8880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-19
Last Update Date:2012-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX240411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty