Provider Demographics
NPI:1902584873
Name:SCUBA HTX, PLLC
Entity Type:Organization
Organization Name:SCUBA HTX, PLLC
Other - Org Name:SCUBA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HODA
Authorized Official - Middle Name:
Authorized Official - Last Name:J
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-888-5244
Mailing Address - Street 1:5827 BISSONNET ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5827 BISSONNET ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4719
Practice Address - Country:US
Practice Address - Phone:832-888-5244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty