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NPI Code Detail

MEDICARE: DR. DWIGHT DANIEL PECCORA D.D.S.

MEDICARE: DR. DWIGHT DANIEL PECCORA D.D.S.
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
1122300000XDentist0025645TX

General Provider Information

NPI Number : 1124330782
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DWIGHT DANIEL PECCORA D.D.S.
Provider Business Mailing Address
First Line : 5819 HIGHWAY 6 STE 230
Second Line :
City : MISSOURI CITY
State : TX
Zip : 77459-4070
Country : US
Telephone Number : 281-499-3541
Fax Number :
Provider Business Practice Location Address
First Line : 5819 HIGHWAY 6 STE 230
Second Line :
City : MISSOURI CITY
State : TX
Zip : 77459-4070
Country : US
Telephone Number : 281-499-3541
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2010
Last Update Date : 07/11/2010

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