Provider Demographics
NPI:1801659271
Name:TEXAS CENTER FOR ADVANCED IMPLANT AND COSMETIC DENTISTRY, PLLC
Entity type:Organization
Organization Name:TEXAS CENTER FOR ADVANCED IMPLANT AND COSMETIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:UMANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-275-4926
Mailing Address - Street 1:6818 ATASCOCITA RD
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2817
Mailing Address - Country:US
Mailing Address - Phone:832-275-4926
Mailing Address - Fax:
Practice Address - Street 1:6818 ATASCOCITA RD
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2817
Practice Address - Country:US
Practice Address - Phone:832-275-4926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental