Provider Demographics
NPI:1962848911
Name:JUSTIN DENTAL HEIGHTS PLLC
Entity Type:Organization
Organization Name:JUSTIN DENTAL HEIGHTS PLLC
Other - Org Name:BLVD DENTISTRY - HEIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR CREDENTIALING TEAM LEAD
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:107 YALE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-3730
Mailing Address - Country:US
Mailing Address - Phone:832-900-2071
Mailing Address - Fax:832-900-2072
Practice Address - Street 1:107 YALE ST STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-3730
Practice Address - Country:US
Practice Address - Phone:832-900-2071
Practice Address - Fax:832-900-2072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-17
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty