MEDICARE: TRINITY HOMESTEAD DENTAL PLLC

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	122300000X	Dentist	21047	TX

General Provider Information

NPI Number	:	1184043390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY HOMESTEAD DENTAL PLLC

Provider Business Mailing Address
First Line	:	7008 LYONS AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77020-5359
Country	:	US
Telephone Number	:	713-674-0811
Fax Number	:

Provider Business Practice Location Address
First Line	:	9417 MESA DR
Second Line	:	#A
City	:	HOUSTON
State	:	TX
Zip	:	77028-1253
Country	:	US
Telephone Number	:	713-674-0811
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AMJAD SHEIKH
Credential	:	DDS
Telephone Number	:	713-674-0811

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	04/15/2014

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