Provider Demographics
NPI:1154690782
Name:SANDEEP P. MAMMEN, D.M.D., P.C.
Entity type:Organization
Organization Name:SANDEEP P. MAMMEN, D.M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:P
Authorized Official - Last Name:MAMMEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:713-777-1774
Mailing Address - Street 1:7324 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 490
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2012
Mailing Address - Country:US
Mailing Address - Phone:713-777-1774
Mailing Address - Fax:713-777-7137
Practice Address - Street 1:7324 SOUTHWEST FWY
Practice Address - Street 2:SUITE 490
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2012
Practice Address - Country:US
Practice Address - Phone:713-777-1774
Practice Address - Fax:713-777-7137
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANDEEP P. MAMMEN, D.M.D., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23225261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1174582522OtherNPI-I