MEDICARE: TEXAS DENTAL ASSOCIATES PA

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	1223E0200X	Endodontics	6626	TX
2	1223G0001X	General Practice Dentistry	6626	TX
3	1223P0221X	Pediatric Dentistry	6626	TX
4	1223P0300X	Periodontics	6626	TX
5	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	6626	TX
6	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	6626	TX
7	122300000X	Dentist	6626	TX

General Provider Information

NPI Number	:	1396285110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS DENTAL ASSOCIATES PA

Provider Business Mailing Address
First Line	:	2536 AMHERST ST STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-3207
Country	:	US
Telephone Number	:	713-490-8880
Fax Number	:

Provider Business Practice Location Address
First Line	:	7112 FM 1960 RD E
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-2702
Country	:	US
Telephone Number	:	713-490-8880
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ORTHODONTIST
Name	:	DR. DONALD W ANDRESS
Credential	:	DDS
Telephone Number	:	713-490-8880

Provider Enumeration Date	:	02/27/2017
Last Update Date	:	03/09/2017

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