Provider Demographics
NPI:1932386836
Name:DENTAL GALLERY
Entity type:Organization
Organization Name:DENTAL GALLERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEHNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SAEEDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-990-8448
Mailing Address - Street 1:102 W EL DORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-6516
Mailing Address - Country:US
Mailing Address - Phone:281-990-8448
Mailing Address - Fax:
Practice Address - Street 1:102 W EL DORADO BLVD
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-6516
Practice Address - Country:US
Practice Address - Phone:281-990-8448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX187781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008381OtherPMI
TX1358544OtherUNITED CORODIA
TX86D847OtherBCBS