Provider Demographics
NPI:1205229655
Name:LIVINGSTON FAMILY DENTISTRY, PLLC
Entity type:Organization
Organization Name:LIVINGSTON FAMILY DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ENAS
Authorized Official - Middle Name:
Authorized Official - Last Name:NIMRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:936-337-0000
Mailing Address - Street 1:411 YAUPON AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-2664
Mailing Address - Country:US
Mailing Address - Phone:936-337-0000
Mailing Address - Fax:
Practice Address - Street 1:411 YAUPON AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-2664
Practice Address - Country:US
Practice Address - Phone:936-337-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX219201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1609980309OtherNPI
TX1346396280OtherINDIVIDUAL NPI