MEDICARE: AFFORDABLE DENTURES & IMPLANTS - TEXAS, 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	122300000X	Dentist	0021124	TX
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1477821577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE DENTURES & IMPLANTS - TEXAS, PLLC

Provider Business Mailing Address
First Line	:	11901 SHADOW CREEK PKWY
Second Line	:	135
City	:	PEARLAND
State	:	TX
Zip	:	77584-7346
Country	:	US
Telephone Number	:	281-372-6234
Fax Number	:	281-741-5847

Provider Business Practice Location Address
First Line	:	11901 SHADOW CREEK PKWY
Second Line	:	135
City	:	PEARLAND
State	:	TX
Zip	:	77584-7346
Country	:	US
Telephone Number	:	281-372-6234
Fax Number	:	281-741-5847

Authorized Official
Title or Position	:	ENROLLMENT SPECIALIST
Name	:	HALEY WOOSTER
Credential	:
Telephone Number	:	712-733-8551

Provider Enumeration Date	:	12/05/2011
Last Update Date	:	11/17/2021

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