Provider Demographics
NPI:1396886560
Name:GOOD SHEPHERD DENTAL CLINIC INC
Entity type:Organization
Organization Name:GOOD SHEPHERD DENTAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TREVINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-771-8883
Mailing Address - Street 1:6220 DASHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-4214
Mailing Address - Country:US
Mailing Address - Phone:713-771-8883
Mailing Address - Fax:713-771-9993
Practice Address - Street 1:6220 DASHWOOD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-4214
Practice Address - Country:US
Practice Address - Phone:713-771-8883
Practice Address - Fax:713-771-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty