MEDICARE: DR. EDUARD VERNOVSKY 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	019023309	IL
2	1223G0001X	General Practice Dentistry	27349	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	:	1245229939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDUARD VERNOVSKY DDS

Provider Business Mailing Address
First Line	:	8200 WEDNESBURY LN
Second Line	:	310
City	:	HOUSTON
State	:	TX
Zip	:	77074-2925
Country	:	US
Telephone Number	:	281-501-0898
Fax Number	:	281-501-0898

Provider Business Practice Location Address
First Line	:	8200 WEDNESBURY LN
Second Line	:	310
City	:	HOUSTON
State	:	TX
Zip	:	77074-2925
Country	:	US
Telephone Number	:	281-501-0898
Fax Number	:	281-501-0898

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	12/05/2011

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