MEDICARE: HOUSTON ENDODONTICS ASSOCIATES, PA

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	1223E0200X	Endodontics	17947	TX

General Provider Information

NPI Number	:	1336213107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTON ENDODONTICS ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	13910 CHAMPION FOREST DR
Second Line	:	SUITE 210
City	:	HOUSTON
State	:	TX
Zip	:	77069-1882
Country	:	US
Telephone Number	:	281-580-5588
Fax Number	:

Provider Business Practice Location Address
First Line	:	13910 CHAMPION FOREST DR
Second Line	:	SUITE 210
City	:	HOUSTON
State	:	TX
Zip	:	77069-1882
Country	:	US
Telephone Number	:	281-580-5588
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	DR. MING MICHAEL WANG
Credential	:	DDS
Telephone Number	:	281-580-5588

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	08/22/2020

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