TIME SQUARE DENTAL GROUP NPI 1225369077

NPI Information

  • NPI: 1225369077
  • Provider Name: TIME SQUARE DENTAL GROUP
  • Classification: Dentist - 1223P0300X
  • Specialization: Periodontics
  • Entity Type: Organization
  • Address: 4450 E SAM HOUSTON PKWY S
    SUITE H2
    PASADENA, TX
    ZIP 77505
  • Phone: (713) 910-7779

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NPI Details

TIME SQUARE DENTAL GROUP is a periodontics dentist in Pasadena, TX. The provider is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. TIME SQUARE DENTAL GROUP NPI is 1225369077. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4450 E SAM HOUSTON PKWY S
SUITE H2
PASADENA, TX
ZIP 77505-950
Phone: (713) 910-7779
Fax: (713) 910-7760

The provider's authorized official is Razan Daccak .
The authorized official title is Owner and has the following contact phone number (713) 910-7779.

The enumeration date for this NPI number is 1/19/2010 and was last updated on 1/19/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223P0300XDentistPeriodonticsYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1190182901MEDICAIDTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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