MEDICARE: A 1 DENTAL

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093048571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A 1 DENTAL

Provider Business Mailing Address
First Line	:	8101 FONDREN RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-5903
Country	:	US
Telephone Number	:	713-774-3999
Fax Number	:

Provider Business Practice Location Address
First Line	:	8101 FONDREN RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-5903
Country	:	US
Telephone Number	:	713-774-3999
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JEANNETH CASTRO
Credential	:	DDS
Telephone Number	:	713-774-3999

Provider Enumeration Date	:	09/15/2009
Last Update Date	:	09/15/2009

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Directions to “A 1 DENTAL ” Practice Location

Language	Start Address	Practice Location

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