MEDICARE: NEW CANEY DENTAL 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	1223G0001X	General Practice Dentistry	25968	TX

General Provider Information

NPI Number	:	1255706685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW CANEY DENTAL PLLC

Provider Business Mailing Address
First Line	:	14623 HAMPTON GREEN LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77044-5789
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4109 HOUSTON HWY
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-4700
Country	:	US
Telephone Number	:	361-482-0416
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	MR. ABHISHEK VERMA
Credential	:
Telephone Number	:	832-369-6775

Provider Enumeration Date	:	12/10/2015
Last Update Date	:	01/14/2019

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Directions to “NEW CANEY DENTAL PLLC ” Practice Location

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