MEDICARE: SUMEET SINGH MALHOTRA DMD

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	0026104	TX
2	1223G0001X	General Practice Dentistry	DN1855463	MA

General Provider Information

NPI Number	:	1174834105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMEET SINGH MALHOTRA DMD

Provider Business Mailing Address
First Line	:	1548 WILDCAT DR
Second Line	:
City	:	PORTLAND
State	:	TX
Zip	:	78374-2814
Country	:	US
Telephone Number	:	361-777-0700
Fax Number	:	361-777-0300

Provider Business Practice Location Address
First Line	:	1548 WILDCAT DR
Second Line	:
City	:	PORTLAND
State	:	TX
Zip	:	78374-2814
Country	:	US
Telephone Number	:	361-777-0700
Fax Number	:	361-777-0300

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

Provider Enumeration Date	:	06/24/2010
Last Update Date	:	09/12/2013

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