Organization
DENTAL ETC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MITCHEL MAI DDS (PRESIDENT)
(713) 703-2915
Entity
Organization
Contact information
Practice address
2945 GULF FWY S STE D, LEAGUE CITY, TX 77573-6771
(281) 534-7300
(281) 534-7299
Mailing address
2945 GULF FWY S STE D, LEAGUE CITY, TX 77573-6771
(281) 534-7300
(281) 534-7299
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
21502
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167196802
—
TX
Enumeration date
09/13/2007
Last updated
09/13/2007
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