Provider Demographics
NPI:1952602682
Name:GULF COAST ENDODONTICS
Entity Type:Organization
Organization Name:GULF COAST ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:C
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:832-379-2696
Mailing Address - Street 1:4949 FAIRMONT PKWY
Mailing Address - Street 2:STE. 215
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3757
Mailing Address - Country:US
Mailing Address - Phone:832-379-2696
Mailing Address - Fax:832-379-2697
Practice Address - Street 1:4949 FAIRMONT PKWY
Practice Address - Street 2:STE. 215
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3757
Practice Address - Country:US
Practice Address - Phone:832-379-2696
Practice Address - Fax:832-379-2697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253561223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty