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Organization

AIRLINE DENTAL CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
IRASEMA CAMPA (ADMINISTRATIVE ASSISTANT)
(713) 697-2631
Entity
Organization

Contact information

Practice address
5990 AIRLINE DR, SUITE 180, HOUSTON, TX 77076-4233
(713) 694-8333
(713) 694-8362
Mailing address
1257 ARCHLEY DR, HOUSTON, TX 77055-6706
(713) 464-3326

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
16842
TX
1223G0001X
General Practice Dentistry
Primary
22558
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
009806301
TX
05
169622101
TX
05
177617101
TX
Enumeration date
03/15/2007
Last updated
02/01/2012
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