MEDICARE: JAMBOREE DENTISTRY 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	24116	TX

General Provider Information

NPI Number	:	1194002592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMBOREE DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	6336 TELEPHONE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-5410
Country	:	US
Telephone Number	:	713-644-3000
Fax Number	:	713-644-3004

Provider Business Practice Location Address
First Line	:	6336 TELEPHONE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-5410
Country	:	US
Telephone Number	:	713-644-3000
Fax Number	:	713-644-3004

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES THEODORE SPIGER
Credential	:	D.M.D.
Telephone Number	:	713-644-3000

Provider Enumeration Date	:	11/14/2011
Last Update Date	:	12/28/2011

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