Provider Demographics
NPI:1871608471
Name:LAUDER ROAD DENTAL CENTER INC
Entity type:Organization
Organization Name:LAUDER ROAD DENTAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-449-4439
Mailing Address - Street 1:2623 LAUDER ROAD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77039-3119
Mailing Address - Country:US
Mailing Address - Phone:281-449-4439
Mailing Address - Fax:281-449-7224
Practice Address - Street 1:2623 LAUDER ROAD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77039-3119
Practice Address - Country:US
Practice Address - Phone:281-449-4439
Practice Address - Fax:281-449-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11108122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty