Provider Demographics
NPI:1992441331
Name:NORTHEAST DENTAL ASSOCIATES
Entity type:Organization
Organization Name:NORTHEAST DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAALINI
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAMAKANNI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-818-8132
Mailing Address - Street 1:19411 MCKAY DR STE 150
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-5715
Mailing Address - Country:US
Mailing Address - Phone:832-818-8132
Mailing Address - Fax:
Practice Address - Street 1:19411 MCKAY DR STE 150
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5715
Practice Address - Country:US
Practice Address - Phone:832-818-8132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty