MEDICARE: METHODIST DENTAL

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	122300000X	Dentist

General Provider Information

NPI Number	:	1336305077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METHODIST DENTAL

Provider Business Mailing Address
First Line	:	13420 TOMBALL PKWY
Second Line	:	STE B
City	:	HOUSTON
State	:	TX
Zip	:	77086-3167
Country	:	US
Telephone Number	:	281-272-0106
Fax Number	:	281-272-0107

Provider Business Practice Location Address
First Line	:	13420 TOMBALL PKWY
Second Line	:	STE B
City	:	HOUSTON
State	:	TX
Zip	:	77086-3167
Country	:	US
Telephone Number	:	281-272-0106
Fax Number	:	281-272-0107

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHAHRZAD JAMEA
Credential	:	D.D.S.
Telephone Number	:	281-272-0106

Provider Enumeration Date	:	08/01/2008
Last Update Date	:	08/01/2008

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Directions to “METHODIST DENTAL ” Practice Location

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