MEDICARE: MARQUETTE S.B., LLC

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	16240	TX

General Provider Information

NPI Number	:	1295014827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARQUETTE S.B., LLC

Provider Business Mailing Address
First Line	:	8323 SOUTHWEST FWY STE 610
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1609
Country	:	US
Telephone Number	:	713-777-9865
Fax Number	:	713-777-5250

Provider Business Practice Location Address
First Line	:	8323 SOUTHWEST FWY STE 610
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1609
Country	:	US
Telephone Number	:	713-777-9865
Fax Number	:	713-777-5250

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CARL O. BELCHER II
Credential	:
Telephone Number	:	713-777-9865

Provider Enumeration Date	:	08/13/2011
Last Update Date	:	08/13/2011

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