MEDICARE: QUAIL VALLEY FAMILY 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	122300000X	Dentist	21817	TX

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	:	1114310828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUAIL VALLEY FAMILY DENTAL

Provider Business Mailing Address
First Line	:	2260 FM 1092 RD
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-1802
Country	:	US
Telephone Number	:	281-499-8340
Fax Number	:

Provider Business Practice Location Address
First Line	:	2260 FM 1092 RD
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-1802
Country	:	US
Telephone Number	:	281-499-8340
Fax Number	:

Authorized Official
Title or Position	:	OWNER/GENERAL DENTIST
Name	:	KHALILAH NATHANISHA MCAFEE
Credential	:	D.D.S.
Telephone Number	:	281-499-8340

Provider Enumeration Date	:	03/05/2015
Last Update Date	:	03/05/2015

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Directions to “QUAIL VALLEY FAMILY DENTAL ” Practice Location

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