Provider Demographics
NPI:1841047628
Name:HOMETOWN DENTAL OF FULSHEAR
Entity type:Organization
Organization Name:HOMETOWN DENTAL OF FULSHEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:832-290-3936
Mailing Address - Street 1:17474 BAYFLOWER
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-2238
Mailing Address - Country:US
Mailing Address - Phone:832-290-3936
Mailing Address - Fax:
Practice Address - Street 1:28830 FM 1093
Practice Address - Street 2:SUITE 120
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441
Practice Address - Country:US
Practice Address - Phone:832-789-1553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental