Provider Demographics
NPI:1962892596
Name:MEYER PARK DENTAL CARE
Entity type:Organization
Organization Name:MEYER PARK DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-728-9000
Mailing Address - Street 1:4774 W BELLFORT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-3434
Mailing Address - Country:US
Mailing Address - Phone:713-728-9000
Mailing Address - Fax:
Practice Address - Street 1:4774 W BELLFORT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-3434
Practice Address - Country:US
Practice Address - Phone:713-728-9000
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
TX13474320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities