Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 29035 | TX |
Y | 1223D0001X | Dental Public Health | 29035 | TX |
NPI | 1295167039 |
---|---|
Provider Name | Melissa Kwan Rooks |
First Address | Houston, TX 77078-2909 |
Second Address | Pasadena, TX 77503-3307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2013 |
Last Update Date | 08/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
345800201 | (05) | TX |