Provider Demographics
NPI:1871980318
Name:JULIO GAITAN D.D.S., P.A.
Entity type:Organization
Organization Name:JULIO GAITAN D.D.S., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GAITAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-796-8130
Mailing Address - Street 1:215 N CRIMSON CLOVER CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77381-3887
Mailing Address - Country:US
Mailing Address - Phone:214-796-8130
Mailing Address - Fax:
Practice Address - Street 1:19100 W LAKE HOUSTON PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-5138
Practice Address - Country:US
Practice Address - Phone:214-300-1427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty