Provider Demographics
NPI:1871322826
Name:GRINOVATION PARK WEST PLLC
Entity type:Organization
Organization Name:GRINOVATION PARK WEST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HARIYALI
Authorized Official - Middle Name:
Authorized Official - Last Name:KASUNDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-944-7480
Mailing Address - Street 1:13180 WESTPARK DR STE 106
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-4936
Mailing Address - Country:US
Mailing Address - Phone:281-759-9191
Mailing Address - Fax:281-759-9197
Practice Address - Street 1:13180 WESTPARK DR STE 106
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-4936
Practice Address - Country:US
Practice Address - Phone:281-759-9191
Practice Address - Fax:281-759-9197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty