Provider Demographics
NPI:1285141614
Name:ST. HOPE FOUNDATION, INC - DENTAL
Entity type:Organization
Organization Name:ST. HOPE FOUNDATION, INC - DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:GOODIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-778-1300
Mailing Address - Street 1:6200 SAVOY DR STE 540
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3338
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6800 WEST LOOP S
Practice Address - Street 2:585
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-7740
Practice Address - Country:US
Practice Address - Phone:281-822-7856
Practice Address - Fax:713-844-8034
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST HOPE FOUNDATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27727122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX314272101Medicaid