MEDICARE: AMIGO DENTAL, DDS, PA

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	19004	TX

General Provider Information

NPI Number	:	1104030410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMIGO DENTAL, DDS, PA

Provider Business Mailing Address
First Line	:	10245 KEMPWOOD DR
Second Line	:	SUITE C
City	:	HOUSTON
State	:	TX
Zip	:	77043-1803
Country	:	US
Telephone Number	:	713-690-8585
Fax Number	:	713-690-8586

Provider Business Practice Location Address
First Line	:	10245 KEMPWOOD DR
Second Line	:	SUITE C
City	:	HOUSTON
State	:	TX
Zip	:	77043-1803
Country	:	US
Telephone Number	:	713-690-8585
Fax Number	:	713-690-8586

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LAM CHI HO
Credential	:	DDS
Telephone Number	:	713-690-8585

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	08/22/2020

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