MEDICARE: DR. MONICA M. CHAMORRO-EZZIE D.D.S., M.S.

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	7022	AZ
2	1223E0200X	Endodontics	22599	TX
3	1223E0200X	Endodontics	0401412127	VA

General Provider Information

NPI Number	:	1417011347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONICA M. CHAMORRO-EZZIE D.D.S., M.S.

Provider Business Mailing Address
First Line	:	4422 OSBY DR.
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096
Country	:	US
Telephone Number	:	713-429-5500
Fax Number	:

Provider Business Practice Location Address
First Line	:	9701 N SAM HOUSTON PKWY E
Second Line	:	STE. 280
City	:	HUMBLE
State	:	TX
Zip	:	77396-4636
Country	:	US
Telephone Number	:	281-491-0069
Fax Number	:	281-491-0083

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	07/17/2015

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