Provider Demographics
NPI:1003205485
Name:DENTAL SPECIALISTS OF TOMBALL, PLLC
Entity type:Organization
Organization Name:DENTAL SPECIALISTS OF TOMBALL, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWSHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-351-0005
Mailing Address - Street 1:1123 ALMA ST
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4518
Mailing Address - Country:US
Mailing Address - Phone:281-351-2200
Mailing Address - Fax:
Practice Address - Street 1:1123 ALMA ST
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4518
Practice Address - Country:US
Practice Address - Phone:281-351-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX199531223E0200X
TX212801223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty