Provider Demographics
NPI:1427712827
Name:ANGELA ISHAK DMD PLLC
Entity type:Organization
Organization Name:ANGELA ISHAK DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISHAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:281-271-5100
Mailing Address - Street 1:6940 KATY GASTON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6480
Mailing Address - Country:US
Mailing Address - Phone:281-271-5100
Mailing Address - Fax:281-271-5110
Practice Address - Street 1:6940 KATY GASTON RD STE 200
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6480
Practice Address - Country:US
Practice Address - Phone:281-271-5100
Practice Address - Fax:281-271-5110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX25225OtherDENTAL LICENSE #