Provider Demographics
NPI:1518799626
Name:KATY PERIODONTICS MANAGEMENT INC
Entity type:Organization
Organization Name:KATY PERIODONTICS MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-392-6000
Mailing Address - Street 1:810 S. MASON RD.
Mailing Address - Street 2:STE. 325
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-3858
Mailing Address - Country:US
Mailing Address - Phone:281-392-6000
Mailing Address - Fax:281-392-6811
Practice Address - Street 1:810 S. MASON RD.
Practice Address - Street 2:STE. 325
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3858
Practice Address - Country:US
Practice Address - Phone:281-392-6000
Practice Address - Fax:281-392-6811
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KATY PERIODONTICS MANAGEMENT, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty