MEDICARE: DESIGN DENTAL GROUP

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	261QD0000X	Dental Clinic/Center	22708	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194083998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESIGN DENTAL GROUP

Provider Business Mailing Address
First Line	:	4500 WASHINGTON AVE
Second Line	:	SUITE 700
City	:	HOUSTON
State	:	TX
Zip	:	77007-5476
Country	:	US
Telephone Number	:	713-869-0334
Fax Number	:	713-869-0339

Provider Business Practice Location Address
First Line	:	4500 WASHINGTON AVE
Second Line	:	SUITE 700
City	:	HOUSTON
State	:	TX
Zip	:	77007-5476
Country	:	US
Telephone Number	:	713-869-0334
Fax Number	:	713-869-0339

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. MELANIE BIBB
Credential	:	D.D.S.
Telephone Number	:	713-869-0334

Provider Enumeration Date	:	04/30/2012
Last Update Date	:	04/30/2012

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