MEDICARE: ATLAS DENTAL LP

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	19895	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	:	1114917846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLAS DENTAL LP

Provider Business Mailing Address
First Line	:	14520 MEMORIAL DR
Second Line	:	M144
City	:	HOUSTON
State	:	TX
Zip	:	77079-5434
Country	:	US
Telephone Number	:	979-233-1581
Fax Number	:	979-233-8355

Provider Business Practice Location Address
First Line	:	1723 N AVENUE K
Second Line	:
City	:	FREEPORT
State	:	TX
Zip	:	77541-3605
Country	:	US
Telephone Number	:	979-233-1581
Fax Number	:	979-233-8355

Authorized Official
Title or Position	:	PARTNER
Name	:	MR. TOM QUANG HUYNH
Credential	:
Telephone Number	:	979-233-1581

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	04/29/2011

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Directions to “ATLAS DENTAL LP ” Practice Location

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