MEDICARE: GRAND PARKWAY PEDIATRIC DENTAL

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	1223P0221X	Pediatric Dentistry

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	:	1194091736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND PARKWAY PEDIATRIC DENTAL

Provider Business Mailing Address
First Line	:	7910 W GRAND PKWY S STE 100
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-5834
Country	:	US
Telephone Number	:	832-222-8687
Fax Number	:

Provider Business Practice Location Address
First Line	:	7910 W GRAND PKWY S STE 100
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-5834
Country	:	US
Telephone Number	:	832-222-8687
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. FAISAL M KHAN
Credential	:	DDS
Telephone Number	:	832-222-8687

Provider Enumeration Date	:	03/28/2012
Last Update Date	:	12/04/2019

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Directions to “GRAND PARKWAY PEDIATRIC DENTAL ” Practice Location

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