Provider Demographics
NPI:1548358138
Name:CHOW, MIMI MAE (DDS)
Entity type:Individual
Prefix:DR
First Name:MIMI
Middle Name:MAE
Last Name:CHOW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 WILLOW SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-4786
Mailing Address - Country:US
Mailing Address - Phone:281-710-7782
Mailing Address - Fax:
Practice Address - Street 1:5631 TELEPHONE RD.
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087
Practice Address - Country:US
Practice Address - Phone:713-644-4446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG60191-02OtherCHIP GROUP #
TX1795189-03Medicaid
TX1795189-04Medicaid