Provider Demographics
NPI:1902321912
Name:GRAND PARKWAY ENDODONTICS
Entity type:Organization
Organization Name:GRAND PARKWAY ENDODONTICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:281-893-1060
Mailing Address - Street 1:1011 MEDICAL PLAZA DR STE 210
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3255
Mailing Address - Country:US
Mailing Address - Phone:281-893-1060
Mailing Address - Fax:281-893-6807
Practice Address - Street 1:1011 MEDICAL PLAZA DR STE 210
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3255
Practice Address - Country:US
Practice Address - Phone:281-893-1060
Practice Address - Fax:281-893-6807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-10
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX252561223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty