MEDICARE: FAMILY DENTISTRY OF HOUSTON PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	25663	TX
2	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013323435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY DENTISTRY OF HOUSTON PC

Provider Business Mailing Address
First Line	:	13145 VETERANS MEMORIAL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-1903
Country	:	US
Telephone Number	:	281-580-4830
Fax Number	:	855-313-5067

Provider Business Practice Location Address
First Line	:	13145 VETERANS MEMORIAL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-1903
Country	:	US
Telephone Number	:	281-580-4830
Fax Number	:	855-313-5067

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CARMEN MARMOL
Credential	:
Telephone Number	:	281-580-4830

Provider Enumeration Date	:	07/07/2014
Last Update Date	:	08/26/2022

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