Innovative Dentistry of Fall Creek, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

24793 Issued in TX

Legal business name

INNOVATIVE DENTISTRY OF FALL CREEK, PLLC

Practice address

8303 N Sam Houston Pkwy E Ste C
Humble, TX 77396-4933

Phone

(346) 616-5350

Fax

(346) 616-5353

NPI assigned

Sep 8, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Edgar Mafla, DDSNPI 1295964989

Title

Owner

Phone

(346) 616-5350

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edgar Mafla, DDS

  • Dentist
  • Humble, TX
  • NPI 1295964989

  General Practice

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1992223127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8303 N SAM HOUSTON PKWY E STE C",
            "city": "HUMBLE",
            "state": "TX",
            "postal_code": "773964933",
            "telephone_number": "346-616-5350",
            "fax_number": "346-616-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8303 N SAM HOUSTON PKWY E STE C",
            "city": "HUMBLE",
            "state": "TX",
            "postal_code": "773964933",
            "telephone_number": "346-616-5350",
            "fax_number": "346-616-5353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE DENTISTRY OF FALL CREEK, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-08",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MAFLA",
        "authorized_official_first_name": "EDGAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "346-616-5350",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "24793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Humble, TX
• Providers in Humble, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.