MEDICARE: ANA PEDIATRIC DENTISTRY 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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1346138096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANA PEDIATRIC DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	15635 KENTWATER CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-2271
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15635 KENTWATER CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-2271
Country	:	US
Telephone Number	:	570-604-9541
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	ARIK AMIN
Credential	:
Telephone Number	:	570-604-9541

Provider Enumeration Date	:	06/24/2025
Last Update Date	:	06/24/2025

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