Organization
SOUTH TEXAS FAMILY DENTISTRY LLC
Active
Other names
South Texas Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
SHERVIN AMINI (CREDENTIALING SPCIALIST)
(713) 647-8199
Entity
Organization
Contact information
Practice address
8200 WEDNESBURY LN STE 108, HOUSTON, TX 77074-2931
(713) 772-2141
Mailing address
8200 WEDNESBURY LN STE 108, HOUSTON, TX 77074-2931
(713) 772-2141
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
23077
TX
251B00000X
Case Management Agency
23077
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23077
LICENSE NUMBER
TX
Enumeration date
07/08/2015
Last updated
08/26/2021
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