Provider Demographics
NPI:1205471950
Name:ALJOUDEH, LINA
Entity type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:ALJOUDEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5022 SUMMER MANOR LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4605
Mailing Address - Country:US
Mailing Address - Phone:917-208-5689
Mailing Address - Fax:
Practice Address - Street 1:9 UVALDE RD STE 12
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-1433
Practice Address - Country:US
Practice Address - Phone:832-564-1620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX358151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics