Provider Demographics
NPI:1316282965
Name:SOUTHWEST HOUSTON DENTAL
Entity type:Organization
Organization Name:SOUTHWEST HOUSTON DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RITCHEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-772-3817
Mailing Address - Street 1:9301 BISSONNET ST STE 165
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1426
Mailing Address - Country:US
Mailing Address - Phone:713-772-3817
Mailing Address - Fax:713-772-6405
Practice Address - Street 1:9301 BISSONNET ST STE 165
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1426
Practice Address - Country:US
Practice Address - Phone:713-772-3817
Practice Address - Fax:713-772-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty