Provider Demographics
NPI:1174969315
Name:YALE SPECIALTY GROUP PLLC
Entity type:Organization
Organization Name:YALE SPECIALTY GROUP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWENR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-900-2071
Mailing Address - Street 1:107 YALE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-3730
Mailing Address - Country:US
Mailing Address - Phone:832-900-2071
Mailing Address - Fax:832-900-2072
Practice Address - Street 1:107 YALE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-3730
Practice Address - Country:US
Practice Address - Phone:832-900-2071
Practice Address - Fax:832-900-2072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255711223E0200X
TX222051223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty