Provider Demographics
NPI:1023478062
Name:ATASCOCITA DENTAL
Entity type:Organization
Organization Name:ATASCOCITA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-852-5690
Mailing Address - Street 1:7820 FM 1960 RD E
Mailing Address - Street 2:204
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2257
Mailing Address - Country:US
Mailing Address - Phone:281-852-5690
Mailing Address - Fax:
Practice Address - Street 1:7820 FM 1960 RD E
Practice Address - Street 2:204
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2257
Practice Address - Country:US
Practice Address - Phone:281-852-5690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATASCOCITA DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX285311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty