MEDICARE: MICHAEL NUGENT DDS 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	22464	TX

General Provider Information

NPI Number	:	1043750664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL NUGENT DDS PC

Provider Business Mailing Address
First Line	:	3421 BURKE RD
Second Line	:	SUITE A
City	:	PASADENA
State	:	TX
Zip	:	77504-1975
Country	:	US
Telephone Number	:	713-941-8261
Fax Number	:	888-293-4807

Provider Business Practice Location Address
First Line	:	3421 BURKE RD
Second Line	:	SUITE A
City	:	PASADENA
State	:	TX
Zip	:	77504-1975
Country	:	US
Telephone Number	:	713-941-8261
Fax Number	:	888-293-4807

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. LISA HOKANSON
Credential	:
Telephone Number	:	713-941-8261

Provider Enumeration Date	:	03/01/2017
Last Update Date	:	03/01/2017

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