Provider Demographics
NPI:1972045722
Name:FOUNTAIN VIEW DENTAL
Entity Type:Organization
Organization Name:FOUNTAIN VIEW DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NISHANO
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-784-8235
Mailing Address - Street 1:2929 FOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-6105
Mailing Address - Country:US
Mailing Address - Phone:713-784-8235
Mailing Address - Fax:713-974-0850
Practice Address - Street 1:2929 FOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-6105
Practice Address - Country:US
Practice Address - Phone:713-784-8235
Practice Address - Fax:713-974-0850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX10126122300000X
TXTX27229122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty