Provider Demographics
NPI:1477642254
Name:SOUTHFRIENDSWOOD DENTAL ASSOCIATION
Entity type:Organization
Organization Name:SOUTHFRIENDSWOOD DENTAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAGSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-482-7731
Mailing Address - Street 1:699 S FRIENDSWOOD DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546
Mailing Address - Country:US
Mailing Address - Phone:281-482-7731
Mailing Address - Fax:281-482-7732
Practice Address - Street 1:699 S FRIENDSWOOD DR
Practice Address - Street 2:SUITE 108
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546
Practice Address - Country:US
Practice Address - Phone:281-482-7731
Practice Address - Fax:281-482-7732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty