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Organization
REVEILLE DENTAL
Active
Organization
REVEILLE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY N PHAN (PRESIDENT)
(713) 645-0200
Entity
Organization
Contact information
Practice address
3722 REVEILLE ST, HOUSTON, TX 77087-4529
(713) 645-0200
(713) 645-0402
Mailing address
3722 REVEILLE ST, HOUSTON, TX 77087-4529
(713) 645-0200
(713) 645-0402
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22438
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
178688101
—
TX
Enumeration date
06/17/2011
Last updated
06/17/2011
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