MEDICARE: NEDITH CASQUETE DDS

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	22293	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22293	OTHER	TX	CHIP

General Provider Information

NPI Number	:	1184709289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEDITH CASQUETE DDS

Provider Business Mailing Address
First Line	:	11302 WINDY CREEK DR
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584
Country	:	US
Telephone Number	:	832-659-7377
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 BROADWAY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77017
Country	:	US
Telephone Number	:	713-643-2500
Fax Number	:	713-643-2797

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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