MEDICARE: CHI FAMILY DENTAL

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	30951	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1760864797	OTHER	TX	NPI TYPE 1

General Provider Information

NPI Number	:	1689027567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHI FAMILY DENTAL

Provider Business Mailing Address
First Line	:	8731 HWY 6
Second Line	:	STE 300
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459
Country	:	US
Telephone Number	:	713-213-2658
Fax Number	:	866-892-0774

Provider Business Practice Location Address
First Line	:	8731 HWY 6
Second Line	:	STE 300
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459
Country	:	US
Telephone Number	:	713-213-2658
Fax Number	:	866-892-0774

Authorized Official
Title or Position	:	OWNER
Name	:	CHI AGNES MBA
Credential	:	DDS
Telephone Number	:	713-213-2658

Provider Enumeration Date	:	07/15/2016
Last Update Date	:	07/15/2016

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Directions to “CHI FAMILY DENTAL ” Practice Location

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