MEDICARE: MR. BRAD MASON BOSWELL DDS

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	13841	TX

General Provider Information

NPI Number	:	1033235221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRAD MASON BOSWELL DDS

Provider Business Mailing Address
First Line	:	3702 TARTAN LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-2410
Country	:	US
Telephone Number	:	713-784-2952
Fax Number	:	713-184-3331

Provider Business Practice Location Address
First Line	:	1800 BERING DR STE 650
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-3170
Country	:	US
Telephone Number	:	713-784-2952
Fax Number	:	713-784-3331

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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