=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750673224
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEIL L. GORME, M.D., D.D.S., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2011
-----------------------------------------------------
Last Update Date | 05/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6560 FANNIN ST 1600
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-2761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-795-4120
-----------------------------------------------------
Fax | 713-795-4123
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6560 FANNIN ST 1600
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-2761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-795-4120
-----------------------------------------------------
Fax | 713-795-4123
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORAL SURGEON
-----------------------------------------------------
Name | DR. NEIL L. GORME
-----------------------------------------------------
Credential | M.D.,D.D.S.
-----------------------------------------------------
Telephone | 713-795-4120
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------