MEDICARE: WASHINGTON MOBILE DENTISTRY

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	261QD0000X	Dental Clinic/Center	21169	TX

General Provider Information

NPI Number	:	1841455201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASHINGTON MOBILE DENTISTRY

Provider Business Mailing Address
First Line	:	8619 RICHMOND AVE
Second Line	:	700
City	:	HOUSTON
State	:	TX
Zip	:	77063-5684
Country	:	US
Telephone Number	:	713-781-3331
Fax Number	:	713-781-3336

Provider Business Practice Location Address
First Line	:	8619 RICHMOND AVE
Second Line	:	700
City	:	HOUSTON
State	:	TX
Zip	:	77063-5684
Country	:	US
Telephone Number	:	713-781-3331
Fax Number	:	713-781-3336

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHARHONDA KAZAN WASHINGTON
Credential	:	DDS
Telephone Number	:	713-781-3331

Provider Enumeration Date	:	07/25/2008
Last Update Date	:	07/25/2008

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Directions to “WASHINGTON MOBILE DENTISTRY ” Practice Location

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