MEDICARE: SKW DENTAL GROUP, PLLC

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

General Provider Information

NPI Number	:	1124749734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKW DENTAL GROUP, PLLC

Provider Business Mailing Address
First Line	:	11601 SHADOW CREEK PKWY STE 111-303
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7283
Country	:	US
Telephone Number	:	281-624-6269
Fax Number	:	281-504-7090

Provider Business Practice Location Address
First Line	:	8323 SOUTHWEST FWY STE 610
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1609
Country	:	US
Telephone Number	:	281-624-6269
Fax Number	:	281-504-7090

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHARHONDA KAZAN WASHINGTON
Credential	:	DDS
Telephone Number	:	832-746-0163

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	09/12/2022

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