Provider Demographics
NPI:1093019630
Name:GMORGAN DENTAL PLLC
Entity type:Organization
Organization Name:GMORGAN DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-782-1800
Mailing Address - Street 1:1611 SPENCER HWY
Mailing Address - Street 2:SUITE H
Mailing Address - City:SOUTH HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77587-3772
Mailing Address - Country:US
Mailing Address - Phone:713-782-1800
Mailing Address - Fax:713-782-1847
Practice Address - Street 1:1611 SPENCER HWY
Practice Address - Street 2:SUITE H
Practice Address - City:SOUTH HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77587-3772
Practice Address - Country:US
Practice Address - Phone:713-782-1800
Practice Address - Fax:713-782-1847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX188501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty