Provider Demographics
NPI:1285099762
Name:SERENITY DENTAL CARE VINTAGE
Entity type:Organization
Organization Name:SERENITY DENTAL CARE VINTAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-301-8433
Mailing Address - Street 1:10220 LOUETTA RD
Mailing Address - Street 2:#400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-2175
Mailing Address - Country:US
Mailing Address - Phone:832-301-8433
Mailing Address - Fax:832-843-7348
Practice Address - Street 1:10220 LOUETTA RD
Practice Address - Street 2:#400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-2175
Practice Address - Country:US
Practice Address - Phone:832-301-8433
Practice Address - Fax:832-843-7348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty