Provider Demographics
NPI:1962010322
Name:DENTALIM PLLC
Entity Type:Organization
Organization Name:DENTALIM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:IDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VARGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-206-4927
Mailing Address - Street 1:11734 BARKER CYPRESS RD STE 113
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2770
Mailing Address - Country:US
Mailing Address - Phone:281-256-8771
Mailing Address - Fax:
Practice Address - Street 1:11734 BARKER CYPRESS RD STE 113
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-2770
Practice Address - Country:US
Practice Address - Phone:281-256-8771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDL-45825847Medicaid