Provider Demographics
NPI:1336448281
Name:DRS MARDAGA AND ESHELMAN ORTHODONTICS
Entity Type:Organization
Organization Name:DRS MARDAGA AND ESHELMAN ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:ESHELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,PC
Authorized Official - Phone:281-255-4746
Mailing Address - Street 1:1017 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-5525
Mailing Address - Country:US
Mailing Address - Phone:281-255-4746
Mailing Address - Fax:281-255-4706
Practice Address - Street 1:1017 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-5525
Practice Address - Country:US
Practice Address - Phone:281-255-4746
Practice Address - Fax:281-255-4706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX134531223X0400X
TX109901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty