Provider Demographics
NPI:1770298614
Name:KATY ULTRA WHITE DENTAL PC
Entity type:Organization
Organization Name:KATY ULTRA WHITE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:267-987-2237
Mailing Address - Street 1:9727 SPRING GREEN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-4141
Mailing Address - Country:US
Mailing Address - Phone:281-697-5200
Mailing Address - Fax:281-697-5207
Practice Address - Street 1:9727 SPRING GREEN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-4141
Practice Address - Country:US
Practice Address - Phone:281-697-5200
Practice Address - Fax:281-697-5207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty