MEDICARE: SHAVE DENTAL HOUSTON 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1922728187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAVE DENTAL HOUSTON PLLC

Provider Business Mailing Address
First Line	:	3648 CYPRESS CREEK PKWY STE 111
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3609
Country	:	US
Telephone Number	:	713-244-6734
Fax Number	:

Provider Business Practice Location Address
First Line	:	3648 CYPRESS CREEK PKWY STE 111
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3609
Country	:	US
Telephone Number	:	713-244-6734
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	CHAD HENDRICKS
Credential	:
Telephone Number	:	612-859-0444

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	08/29/2022

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Directions to “SHAVE DENTAL HOUSTON PLLC ” Practice Location

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