MEDICARE: SOUTHWEST HOUSTON DENTAL

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

General Provider Information

NPI Number	:	1316282965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST HOUSTON DENTAL

Provider Business Mailing Address
First Line	:	9301 BISSONNET ST STE 165
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1426
Country	:	US
Telephone Number	:	713-772-3817
Fax Number	:	713-772-6405

Provider Business Practice Location Address
First Line	:	9301 BISSONNET ST STE 165
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1426
Country	:	US
Telephone Number	:	713-772-3817
Fax Number	:	713-772-6405

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRYAN RITCHEY
Credential	:	DDS
Telephone Number	:	713-772-3817

Provider Enumeration Date	:	12/10/2012
Last Update Date	:	01/09/2013

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Directions to “SOUTHWEST HOUSTON DENTAL ” Practice Location

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