Provider Demographics
NPI:1194374462
Name:MISSION BEND FAMILY DENTISTRY
Entity type:Organization
Organization Name:MISSION BEND FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-500-4940
Mailing Address - Street 1:7039 FM 1464 RD STE 130
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2001
Mailing Address - Country:US
Mailing Address - Phone:832-500-4940
Mailing Address - Fax:832-532-7392
Practice Address - Street 1:7039 FM 1464 RD STE 130
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2001
Practice Address - Country:US
Practice Address - Phone:832-500-4940
Practice Address - Fax:832-532-7392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental