Provider Demographics
NPI:1356526248
Name:ELIZABETH CARRILLO D.M.D. P.A
Entity type:Organization
Organization Name:ELIZABETH CARRILLO D.M.D. P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:713-692-7600
Mailing Address - Street 1:5803 AIRLINE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-4922
Mailing Address - Country:US
Mailing Address - Phone:713-692-7600
Mailing Address - Fax:713-692-7649
Practice Address - Street 1:5803 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4922
Practice Address - Country:US
Practice Address - Phone:713-692-7600
Practice Address - Fax:713-692-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty