Individual
AI LE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
5858 S GESSNER RD STE 104, HOUSTON, TX 77036-2646
(713) 777-8743
(713) 588-8680
Mailing address
5858 S GESSNER RD STE 104, HOUSTON, TX 77036-2646
(713) 777-8743
(713) 588-8680
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
26142
TX
1223G0001X
General Practice Dentistry
UTSA920-X
TX
Other
Enumeration date
12/02/2010
Last updated
06/04/2019
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