Provider Demographics
NPI:1881263150
Name:GODONTICS
Entity type:Organization
Organization Name:GODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:S
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-955-4224
Mailing Address - Street 1:11625 BROADWAY ST.
Mailing Address - Street 2:SUITE #185
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584
Mailing Address - Country:US
Mailing Address - Phone:713-955-4224
Mailing Address - Fax:713-955-4399
Practice Address - Street 1:11625 BROADWAY ST.
Practice Address - Street 2:SUITE #185
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584
Practice Address - Country:US
Practice Address - Phone:713-955-4224
Practice Address - Fax:713-955-4399
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GODONTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty