Provider Demographics
NPI:1912480740
Name:HOUSTON RED OAK DRIVE DENTAL, PC
Entity Type:Organization
Organization Name:HOUSTON RED OAK DRIVE DENTAL, PC
Other - Org Name:NORTHWEST PEDIATRIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-603-4763
Mailing Address - Street 1:27326 ROBINSON RD STE 108
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE NORTH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-8960
Mailing Address - Country:US
Mailing Address - Phone:281-586-4600
Mailing Address - Fax:281-586-7051
Practice Address - Street 1:27326 ROBINSON RD STE 108
Practice Address - Street 2:
Practice Address - City:OAK RIDGE NORTH
Practice Address - State:TX
Practice Address - Zip Code:77385-8960
Practice Address - Country:US
Practice Address - Phone:281-586-4600
Practice Address - Fax:281-586-7051
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSTON RED OAK DRIVE DENTAL, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-07
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20388261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental