Provider Demographics
NPI:1902296494
Name:CAMMARATA PEDIATRIC DENTISTRY GROUP
Entity type:Organization
Organization Name:CAMMARATA PEDIATRIC DENTISTRY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-666-7884
Mailing Address - Street 1:5252 WESTCHESTER ST
Mailing Address - Street 2:SUITE 190
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-4141
Mailing Address - Country:US
Mailing Address - Phone:713-666-7884
Mailing Address - Fax:
Practice Address - Street 1:5252 WESTCHESTER ST
Practice Address - Street 2:SUITE 190
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-4141
Practice Address - Country:US
Practice Address - Phone:713-666-7884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX195831223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty