Provider Demographics
NPI:1699541276
Name:PEARL DENTISTRY HUMBLE PLLC
Entity type:Organization
Organization Name:PEARL DENTISTRY HUMBLE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-648-7632
Mailing Address - Street 1:507 N SAM HOUSTON PKWY E STE 555
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-4152
Mailing Address - Country:US
Mailing Address - Phone:832-474-5406
Mailing Address - Fax:832-532-1904
Practice Address - Street 1:11501 N SAM HOUSTON PKWY E STE C
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-4635
Practice Address - Country:US
Practice Address - Phone:832-648-7632
Practice Address - Fax:832-532-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty