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NPI Code Detail

MEDICARE: SOUTH HOUSTON FAMILY DENTAL

MEDICARE: SOUTH HOUSTON FAMILY 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
1122300000XDentist19772TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467727347
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH HOUSTON FAMILY DENTAL
Provider Business Mailing Address
First Line : 701 COLLEGE AVE
Second Line :
City : SOUTH HOUSTON
State : TX
Zip : 77587-4205
Country : US
Telephone Number : 713-941-7555
Fax Number : 713-951-7527
Provider Business Practice Location Address
First Line : 701 COLLEGE AVE
Second Line :
City : SOUTH HOUSTON
State : TX
Zip : 77587-4205
Country : US
Telephone Number : 713-941-7555
Fax Number : 713-951-7527
Authorized Official
Title or Position : DENTIST
Name : DR. PRIYA T GANJU
Credential : D.D.S.
Telephone Number : 713-941-7555
Provider Enumeration Date : 03/12/2012
Last Update Date : 03/12/2012

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Directions to “SOUTH HOUSTON FAMILY DENTAL ” Practice Location

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