Provider Demographics
NPI:1316716129
Name:CITYDDS, PLLC
Entity type:Organization
Organization Name:CITYDDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:ILUSTRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-863-2702
Mailing Address - Street 1:17100 GLENMOUNT PARK DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4368
Mailing Address - Country:US
Mailing Address - Phone:281-488-2483
Mailing Address - Fax:
Practice Address - Street 1:17100 GLENMOUNT PARK DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4368
Practice Address - Country:US
Practice Address - Phone:281-488-2483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223D0004XDental ProvidersDentistDental AnesthesiologyGroup - Multi-Specialty