MEDICARE: FAMILY ORAL HEALTH AND ORTHODONTIC 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

General Provider Information

NPI Number	:	1669323267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY ORAL HEALTH AND ORTHODONTIC PLLC

Provider Business Mailing Address
First Line	:	6863 TURTLEWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-2751
Country	:	US
Telephone Number	:	713-977-6917
Fax Number	:	713-534-1354

Provider Business Practice Location Address
First Line	:	6400 WEST PARK DR. SUITE 430
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-7202
Country	:	US
Telephone Number	:	713-977-6917
Fax Number	:	713-534-1354

Authorized Official
Title or Position	:	DENTIST
Name	:	JOSE ANGEL RIVERA-GAUTIER
Credential	:	DMD
Telephone Number	:	713-977-6917

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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