Provider Demographics
NPI:1194490847
Name:COSMOPOLITAN DENTISTRY INC
Entity type:Organization
Organization Name:COSMOPOLITAN DENTISTRY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLOUCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:281-857-6321
Mailing Address - Street 1:11930 BROADWAY ST STE 130
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8448
Mailing Address - Country:US
Mailing Address - Phone:281-857-6321
Mailing Address - Fax:281-857-6322
Practice Address - Street 1:11930 BROADWAY ST # 130
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8448
Practice Address - Country:US
Practice Address - Phone:281-857-6321
Practice Address - Fax:281-857-6322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental