MEDICARE: TANGLEWOOD DENTAL ASSOCIATES,P.C.,D.D.S

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	13841	TX

General Provider Information

NPI Number	:	1255593711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TANGLEWOOD DENTAL ASSOCIATES,P.C.,D.D.S

Provider Business Mailing Address
First Line	:	1800 BERING DR
Second Line	:	SUITE 650
City	:	HOUSTON
State	:	TX
Zip	:	77057-3151
Country	:	US
Telephone Number	:	713-784-3331
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 BERING DR
Second Line	:	SUITE 650
City	:	HOUSTON
State	:	TX
Zip	:	77057-3151
Country	:	US
Telephone Number	:	713-784-2952
Fax Number	:	713-784-2952

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. BRAD MASON BOSWELL
Credential	:	D.D.S
Telephone Number	:	713-784-2952

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	06/26/2008

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