Provider Demographics
NPI:1215616974
Name:CROSBY PLAZA DENTAL PLLC
Entity type:Organization
Organization Name:CROSBY PLAZA DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDROZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-781-9117
Mailing Address - Street 1:507 BOMAR ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-1406
Mailing Address - Country:US
Mailing Address - Phone:817-781-9117
Mailing Address - Fax:
Practice Address - Street 1:105 KENNINGS RD STE 2
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-5128
Practice Address - Country:US
Practice Address - Phone:817-781-9117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty