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Organization
AIRLINE DENTAL CLINIC
Active
Organization
AIRLINE DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRASEMA CAMPA (ADMINISTRATIVE ASSISTANT)
(713) 697-2631
Entity
Organization
Contact information
Practice address
5990 AIRLINE DR, SUITE 180, HOUSTON, TX 77076-4233
(713) 694-8333
(713) 694-8362
Mailing address
1257 ARCHLEY DR, HOUSTON, TX 77055-6706
(713) 464-3326
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
16842
TX
1223G0001X
General Practice Dentistry
Primary
22558
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009806301
—
TX
05
—
169622101
—
TX
05
—
177617101
—
TX
Enumeration date
03/15/2007
Last updated
02/01/2012
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