Provider Demographics
NPI:1750790127
Name:SERENITY DENTAL CARE PLLC
Entity type:Organization
Organization Name:SERENITY DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-305-8835
Mailing Address - Street 1:6519 FM 1488 RD
Mailing Address - Street 2:SUITE 505
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-3263
Mailing Address - Country:US
Mailing Address - Phone:281-305-8835
Mailing Address - Fax:
Practice Address - Street 1:6519 FM 1488 RD
Practice Address - Street 2:SUITE 505
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-3263
Practice Address - Country:US
Practice Address - Phone:281-305-8835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-10
Last Update Date:2014-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30358122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty