Provider Demographics
NPI:1932572211
Name:ADAGIO DENTAL, PLLC
Entity type:Organization
Organization Name:ADAGIO DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HELENE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-695-3455
Mailing Address - Street 1:10424 IH 10 E
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77523
Mailing Address - Country:US
Mailing Address - Phone:832-895-3455
Mailing Address - Fax:
Practice Address - Street 1:10424 IH 10
Practice Address - Street 2:SUITE 300
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77523
Practice Address - Country:US
Practice Address - Phone:832-695-3455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25675261QD0000X
TX25872261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental