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NPI Code Detail

MEDICARE: MEMORIAL DENTISTRY FOR KIDS PLLC

MEDICARE: MEMORIAL DENTISTRY FOR KIDS 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
11223P0221XPediatric Dentistry

General Provider Information

NPI Number : 1326647454
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEMORIAL DENTISTRY FOR KIDS PLLC
Provider Business Mailing Address
First Line : 14090 MEMORIAL DR
Second Line :
City : HOUSTON
State : TX
Zip : 77079-6848
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 14090 MEMORIAL DR
Second Line :
City : HOUSTON
State : TX
Zip : 77079-6848
Country : US
Telephone Number : 713-714-1244
Fax Number :
Authorized Official
Title or Position : EMPLOYEE
Name : ARYA DAVOODY
Credential :
Telephone Number : 443-253-9970
Provider Enumeration Date : 10/20/2020
Last Update Date : 10/20/2020

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Directions to “MEMORIAL DENTISTRY FOR KIDS PLLC ” Practice Location

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