MEDICARE: PREFERRED DENTAL CARE

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

General Provider Information

NPI Number	:	1649654674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED DENTAL CARE

Provider Business Mailing Address
First Line	:	4723 HIGHWAY 6
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-3988
Country	:	US
Telephone Number	:	281-261-0555
Fax Number	:

Provider Business Practice Location Address
First Line	:	4723 HIGHWAY 6
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-3988
Country	:	US
Telephone Number	:	281-261-0555
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AJI VARGHESE
Credential	:
Telephone Number	:	832-722-2885

Provider Enumeration Date	:	07/20/2015
Last Update Date	:	07/20/2015

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Directions to “PREFERRED DENTAL CARE ” Practice Location

Language	Start Address	Practice Location

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