Provider Demographics
NPI:1770948739
Name:DAVID DE JONGH DDS
Entity type:Organization
Organization Name:DAVID DE JONGH DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DE JONGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-912-6670
Mailing Address - Street 1:13141 FM 1960 RD W
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5278
Mailing Address - Country:US
Mailing Address - Phone:832-912-6670
Mailing Address - Fax:832-912-6679
Practice Address - Street 1:13141 FM 1960 RD W
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5278
Practice Address - Country:US
Practice Address - Phone:832-912-6670
Practice Address - Fax:832-912-6679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12649332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies