Provider Demographics
NPI:1972156347
Name:PURE DENTAL ORAL SURGERY PLLC
Entity type:Organization
Organization Name:PURE DENTAL ORAL SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FIELD
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-821-6468
Mailing Address - Street 1:11811 NORTH FWY STE 600
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-3261
Mailing Address - Country:US
Mailing Address - Phone:281-606-0515
Mailing Address - Fax:
Practice Address - Street 1:2225 N SHEPHERD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1953
Practice Address - Country:US
Practice Address - Phone:281-836-4520
Practice Address - Fax:713-487-4103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty