MEDICARE: DR. THOMAIS IOANNOU DMD, MSD

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	37883	TX

General Provider Information

NPI Number	:	1114684529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAIS IOANNOU DMD, MSD

Provider Business Mailing Address
First Line	:	10710 CENTRE FOREST DRIVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9412 GAYLORD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-3034
Country	:	US
Telephone Number	:	713-464-7777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2021
Last Update Date	:	11/19/2021

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