MEDICARE: NORTHWEST FAMILY DENTISTRY

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	15415	TX
2	1223G0001X	General Practice Dentistry	15764	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	:	1316080088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	2120 W 18TH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1210
Country	:	US
Telephone Number	:	713-861-7078
Fax Number	:	713-861-8065

Provider Business Practice Location Address
First Line	:	2120 W 18TH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1210
Country	:	US
Telephone Number	:	713-861-7078
Fax Number	:	713-861-8065

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	DR. ANDREW WONG
Credential	:	D.D.S.
Telephone Number	:	713-861-7078

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	05/29/2019

Similar Medicare Providers

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Directions to “NORTHWEST FAMILY DENTISTRY ” Practice Location

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