MEDICARE: SERENITY DENTAL CARE 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	30358	TX

General Provider Information

NPI Number	:	1750790127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY DENTAL CARE PLLC

Provider Business Mailing Address
First Line	:	6519 FM 1488 RD
Second Line	:	SUITE 505
City	:	MAGNOLIA
State	:	TX
Zip	:	77354-3263
Country	:	US
Telephone Number	:	281-305-8835
Fax Number	:

Provider Business Practice Location Address
First Line	:	6519 FM 1488 RD
Second Line	:	SUITE 505
City	:	MAGNOLIA
State	:	TX
Zip	:	77354-3263
Country	:	US
Telephone Number	:	281-305-8835
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	JEFFERY CHUNG
Credential	:
Telephone Number	:	281-305-8835

Provider Enumeration Date	:	08/10/2014
Last Update Date	:	08/10/2014

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