MEDICARE: 21ST CENTURY DENTISTRY

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	14074	TX

General Provider Information

NPI Number	:	1104092352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	21ST CENTURY DENTISTRY

Provider Business Mailing Address
First Line	:	9630 CLAREWOOD DR STE A 4
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036
Country	:	US
Telephone Number	:	713-774-1136
Fax Number	:	713-774-1544

Provider Business Practice Location Address
First Line	:	9630 CLAREWOOD DR STE A4
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-3535
Country	:	US
Telephone Number	:	713-774-1136
Fax Number	:	713-774-1544

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WENDER JIANG
Credential	:	M.S.
Telephone Number	:	713-774-1136

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	05/07/2008

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Directions to “21ST CENTURY DENTISTRY ” Practice Location

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