MEDICARE: UPTOWN GENERAL & COSMETIC DENTISRY, P.A.

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	18883	TX

General Provider Information

NPI Number	:	1124313713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPTOWN GENERAL & COSMETIC DENTISRY, P.A.

Provider Business Mailing Address
First Line	:	13420 TOMBALL PKWY
Second Line	:	SUITE B
City	:	HOUSTON
State	:	TX
Zip	:	77086-3167
Country	:	US
Telephone Number	:	281-272-0106
Fax Number	:	281-272-0107

Provider Business Practice Location Address
First Line	:	13420 TOMBALL PKWY
Second Line	:	SUITE B
City	:	HOUSTON
State	:	TX
Zip	:	77086-3167
Country	:	US
Telephone Number	:	281-272-0106
Fax Number	:	281-272-0107

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHAHRZAD JAMEA
Credential	:	D.D.S.
Telephone Number	:	281-272-0106

Provider Enumeration Date	:	06/13/2011
Last Update Date	:	06/13/2011

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