# EAGLE DENTAL P.C.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SUN DENTAL GROUP P.A.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1073832291
- **Legal business name:** SUN DENTAL GROUP P.A.
- **Authorized official:** DR. DAVIN E ODIA DDS (OWNER)
- **Authorized official phone:** (832) 790-2223

## Contact information

- **Practice address:** 12609 S GESSNER DR, HOUSTON, TX 77071-2803
- **Practice address phone:** (713) 774-6700
- **Practice address fax:** (713) 774-6704
- **Mailing address:** 12609 S. GESSNER DRIVE, STE. F, HOUSTON, TX 77071-2803
- **Mailing address phone:** (713) 774-6700
- **Mailing address fax:** (713) 774-6704

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 22575 | TX | Yes |

## Other

- **Enumeration date:** 05/27/2010
- **Last updated:** 06/23/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 190960801 | — | TX |
| 05 | — | 214288701 | — | TX |
| 01 | — | B22575-01 | CHIP | — |
| 01 | — | B22575-02 | CHIP | — |