Organization
SPACE CITY PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRET A IBARRA DDS, MSD (OWNER)
(281) 484-7732
Entity
Organization
Contact information
Practice address
18174 GULF FWY STE 100, FRIENDSWOOD, TX 77546-2722
(281) 484-7732
(888) 397-0197
Mailing address
18174 GULF FWY STE 100, FRIENDSWOOD, TX 77546-2722
(281) 484-7732
(281) 484-8751
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
10310
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009757801
—
TX
05
—
1487811659
—
TX
05
—
220062801
—
TX
Enumeration date
05/16/2008
Last updated
10/30/2023
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