MEDICARE: WESTHEIMER MINT 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1467813709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTHEIMER MINT DENTISTRY, PLLC

Provider Business Mailing Address
First Line	:	15115 WESTHEIMER RD
Second Line	:	#K
City	:	HOUSTON
State	:	TX
Zip	:	77082-1665
Country	:	US
Telephone Number	:	713-821-6468
Fax Number	:

Provider Business Practice Location Address
First Line	:	15115 WESTHEIMER RD
Second Line	:	#K
City	:	HOUSTON
State	:	TX
Zip	:	77082-1665
Country	:	US
Telephone Number	:	713-821-6468
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	JENNIFER SGRILLO
Credential	:
Telephone Number	:	214-821-6468

Provider Enumeration Date	:	03/15/2016
Last Update Date	:	03/15/2016

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