MEDICARE: DR. SARAH AMIDZADEH D.D.S

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	30107	TX

General Provider Information

NPI Number	:	1003220286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH AMIDZADEH D.D.S

Provider Business Mailing Address
First Line	:	7709 CAMBRIDGE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2039
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9150 MAIN ST
Second Line	:	SUITE I
City	:	HOUSTON
State	:	TX
Zip	:	77025-3843
Country	:	US
Telephone Number	:	713-665-7707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2014
Last Update Date	:	06/16/2014

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