MEDICARE: GEETEE DENTAL CENTER 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	31363	TX

General Provider Information

NPI Number	:	1043662976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEETEE DENTAL CENTER PLLC

Provider Business Mailing Address
First Line	:	1414 ELDRIDGE PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-1625
Country	:	US
Telephone Number	:	281-496-0515
Fax Number	:

Provider Business Practice Location Address
First Line	:	1414 ELDRIDGE PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-1625
Country	:	US
Telephone Number	:	281-496-0515
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GANIYU TAIWO ABIB
Credential	:	DMD
Telephone Number	:	281-496-0515

Provider Enumeration Date	:	07/03/2016
Last Update Date	:	07/03/2016

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