Organization
FAIRFIELD PROFESSIONAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANYA AMADOR (OFFICE MANAGER)
(713) 694-8800
Entity
Organization
Contact information
Practice address
28070 HIGHWAY 290 STE 150, CYPRESS, TX 77433-6921
(281) 373-4000
Mailing address
28070 HIGHWAY 290 STE 150, CYPRESS, TX 77433-6921
(281) 373-4000
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
19674
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007805705
—
TX
Enumeration date
05/19/2017
Last updated
07/21/2022
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