Organization
TIME SQUARE DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAZAN DACCAK D.D.S. (OWNER)
(713) 910-7779
Entity
Organization
Contact information
Practice address
4450 E SAM HOUSTON PKWY S, SUITE H2, PASADENA, TX 77505-3950
(713) 910-7779
(713) 910-7760
Mailing address
PO BOX 460182, HOUSTON, TX 77056-8182
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190182901
—
TX
Enumeration date
01/19/2010
Last updated
01/19/2010
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