Provider Demographics
NPI:1972727519
Name:METROPOLITAN DENTAL ASSOCIATES PA
Entity Type:Organization
Organization Name:METROPOLITAN DENTAL ASSOCIATES PA
Other - Org Name:SMILE STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-523-2328
Mailing Address - Street 1:2315 SOUTHWEST FWY
Mailing Address - Street 2:SUITE #200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-4700
Mailing Address - Country:US
Mailing Address - Phone:713-523-2328
Mailing Address - Fax:713-528-5542
Practice Address - Street 1:2315 SOUTHWEST FWY
Practice Address - Street 2:SUITE #200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4700
Practice Address - Country:US
Practice Address - Phone:713-523-2328
Practice Address - Fax:713-528-5542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty