MEDICARE: TEXAS PREMIER DENTAL - SPRING BRANCH, 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	1223G0001X	General Practice Dentistry		TX

General Provider Information

NPI Number	:	1578987475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS PREMIER DENTAL - SPRING BRANCH, PLLC

Provider Business Mailing Address
First Line	:	17330 SPRING CYPRESS RD STE 115
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77429-4294
Country	:	US
Telephone Number	:	281-256-3222
Fax Number	:	281-256-0629

Provider Business Practice Location Address
First Line	:	2030 N. GESSNER RD STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77080-6342
Country	:	US
Telephone Number	:	713-984-1115
Fax Number	:	713-984-1119

Authorized Official
Title or Position	:	OWNER/GENERAL DENTIST
Name	:	DR. ALIASGAR Y. MOGRI
Credential	:
Telephone Number	:	713-984-1115

Provider Enumeration Date	:	02/12/2014
Last Update Date	:	05/02/2014

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