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NPI Code Detail

MEDICARE: SOUTH TEXAS DENTAL ASSOCIATES, LP

MEDICARE: SOUTH TEXAS DENTAL ASSOCIATES, LP
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
11223G0001XGeneral Practice Dentistry16570TX

General Provider Information

NPI Number : 1215378138
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH TEXAS DENTAL ASSOCIATES, LP
Provider Business Mailing Address
First Line : 6300 WEST LOOP S STE 650
Second Line :
City : BELLAIRE
State : TX
Zip : 77401-2997
Country : US
Telephone Number : 713-457-3445
Fax Number :
Provider Business Practice Location Address
First Line : 6729 AIRLINE DR
Second Line :
City : HOUSTON
State : TX
Zip : 77076-3522
Country : US
Telephone Number : 713-590-0400
Fax Number :
Authorized Official
Title or Position : OFFICER/PARTNER
Name : DR. BARRY GOMEL
Credential : DDS
Telephone Number : 713-457-3445
Provider Enumeration Date : 07/08/2013
Last Update Date : 07/08/2013

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Directions to “SOUTH TEXAS DENTAL ASSOCIATES, LP ” Practice Location

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