Provider Demographics
NPI:1194580092
Name:CONROE DENTAL ASSOCIATES
Entity type:Organization
Organization Name:CONROE DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-683-9110
Mailing Address - Street 1:4300 DUNLAVY ST APT 2135
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5404
Mailing Address - Country:US
Mailing Address - Phone:817-683-9110
Mailing Address - Fax:
Practice Address - Street 1:333 N RIVERSHIRE DR STE 280
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2799
Practice Address - Country:US
Practice Address - Phone:936-756-9884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental