TIME SQUARE DENTAL GROUP (NPI# 1225369077) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225369077 |
| Entity Type | Organization |
| Organization Name | TIME SQUARE DENTAL GROUP |
| Practice Address |
4450 E Sam Houston Pkwy S Suite H2 Pasadena TX 77505-3950 |
| Mailing Address |
Po Box 460182 Houston TX 77056-8182 |
| Practice Telephone | 7139107779 |
| Practice Fax Number | 7139107760 |
| Enumeration Date | 2010-01-19 |
| Last Update Date | 2010-01-19 |
| Authorized Official Name | DR. RAZAN DACCAK (OWNER) |
| Authorized Official Telephone | 7139107779 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 190182901 | 05 |
| Street Address |
4450 E SAM HOUSTON PKWY S SUITE H2 |
| City | PASADENA |
| State | TX |
| Zip Code | 77505-3950 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285686485 | Stephen Hakimi | Optometrist | 4450 E Sam Houston Pkwy S, Suite E, Pasadena, TX 77505-3950 | 2006-05-16 |
| 1154765097 | Megan Shonebarger | Physician Assistant | 4450 E Sam Houston Pkwy S, Suite H2, Pasadena, TX 77505-3950 | 2013-04-22 |
| 1679763213 | Razan Daccak | Dentist | 4450 E Sam Houston Pkwy S, Suite H, Pasadena, TX 77505 | 2007-07-30 |
| 1780629840 | Rukan Daccak | Internal Medicine | 4450 E Sam Houston Pkwy S, Ste H2, Pasadena, TX 77505-3950 | 2006-06-20 |
| 1154373942 | Scott Eric Segal | Ophthalmology | 4450 E Sam Houston Pkwy S, Suit E, Pasadena, TX 77505-3950 | 2006-05-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316545742 | Travis Jones | Pharmacist | 6767 Spencer Highway, Pasadena, TX 77505 | 2020-10-16 |
| 1952872905 | Bay Area Internal Medicine Care Pllc | Internal Medicine | Baywood Crossing Rehabilitation and Healthcare Center, 5020 Space Center Blvd., Pasadena, TX 77505 | 2018-12-16 |
| 1750851325 | Leslie Jackson | Nurse Practitioner | 7106 Spencer Highway, Pasadena, TX 77505 | 2018-11-27 |
| 1093297459 | Hieu Ngoc Minh Hutt | Occupational Therapy Assistant | 4900 East Sam Houston Pkwy S, Pasadena, TX 77505 | 2018-09-02 |
| 1780189142 | Basewave Properties, Pllc | Psychiatry & Neurology | 4808 Fairmont Pkwy, #404, Pasadena, TX 77505 | 2018-03-28 |
| 1720596141 | Lyanne Marlen Fernandez | Specialist/Technologist | 6565 Spencer Hwy Apt 1114, Pasadena, TX 77505 | 2018-01-19 |
| 1073069811 | Sng - Pasadena Dialysis Center Lp | Clinic/Center | 5040 Crenshaw Rd, Ste 200, Pasadena, TX 77505 | 2016-08-31 |
| 1235683418 | Sharon Li | Nurse Practitioner | 4001 Preston Rd #100, Pasadena, TX 77505 | 2016-08-05 |
| 1225493687 | Skkz, Inc. | Clinic/Center | 6415 Fairmont Pkwy, Ste A, Pasadena, TX 77505 | 2015-12-29 |
| 1982026530 | Aerocare Home Medical, Inc. | Durable Medical Equipment & Medical Supplies | 5041 Spencer Hwy, Suite 603, Pasadena, TX 77505 | 2014-01-16 |
| Find all providers in zip 77505 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| 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. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417381799 | American Dental Implant Center | Dentist | 3007 Huntington Dr Ste 201, Pasadena, CA 91107-5522 | 2013-08-22 |
| 1275787210 | Mak and Kleiger, D.d.s. | Dentist | 959 E Walnut St Ste 216, Pasadena, CA 91106-5362 | 2008-11-04 |
| 1215133061 | Bertina Carmen Yuen | Dentist | 247 N Lake Ave, Pasadena, CA 91101-1828 | 2007-06-26 |
| 1508088675 | David R. Wyndhamsmith, A Professional Dental Corporation | Dentist | 1092 E Green St, Pasadena, CA 91106-2506 | 2007-05-02 |
| 1497972434 | Joel B. Henriod | Dentist | 72 N Hill Ave, Pasadena, CA 91106-1905 | 2007-04-19 |
| 1942328604 | Krikor Simonian | Dentist | 1156 E Green St, Suite 102, Pasadena, CA 91106-2515 | 2007-03-27 |
| 1386706828 | Anoushka Tandon | Dentist | 5106 Fairmont Parkway, Pasadena, TX 77505 | 2006-12-14 |
| 1669484689 | Charles Martin Brown | Dentist | 4010 Vista Rd Ste C, Pasadena, TX 77504-2140 | 2006-08-12 |
| 1134124761 | Allan Howard Charles | Dentist | 747 Locust St Ste 200, Ste 204, Pasadena, CA 91101-4457 | 2005-06-20 |
| 1689946980 | Miller & Henriod Dental Partnership | Dentist | 72 N Hill Ave, Pasadena, CA 91106-1905 | 2012-02-01 |
| Find all providers in PASADENA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.