Provider Demographics
NPI:1215284377
Name:EZERNACK, LENORE RUTH (DDS)
Entity type:Individual
Prefix:DR
First Name:LENORE
Middle Name:RUTH
Last Name:EZERNACK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 GRIGGS RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-3760
Mailing Address - Country:US
Mailing Address - Phone:713-454-5016
Mailing Address - Fax:713-454-5018
Practice Address - Street 1:5230 GRIGGS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-3760
Practice Address - Country:US
Practice Address - Phone:713-454-5016
Practice Address - Fax:713-454-5018
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice