Provider Demographics
NPI:1699248161
Name:G ORTHODONTICS
Entity type:Organization
Organization Name:G ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YESENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:713-436-1241
Mailing Address - Street 1:12004 SHADOW CREEK PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7327
Mailing Address - Country:US
Mailing Address - Phone:713-436-1241
Mailing Address - Fax:713-730-3656
Practice Address - Street 1:12004 SHADOW CREEK PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7327
Practice Address - Country:US
Practice Address - Phone:713-436-1241
Practice Address - Fax:713-730-3656
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:G ORTHODONTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-08
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty