MEDICARE: COSMETIC DENTIST OF KATY, P.A

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	1223P0300X	Periodontics

General Provider Information

NPI Number	:	1356567630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COSMETIC DENTIST OF KATY, P.A

Provider Business Mailing Address
First Line	:	929 S MASON RD
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-3874
Country	:	US
Telephone Number	:	281-579-6066
Fax Number	:

Provider Business Practice Location Address
First Line	:	929 S MASON RD
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-3874
Country	:	US
Telephone Number	:	281-579-6066
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DINH X BUI
Credential	:
Telephone Number	:	281-579-6066

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	08/22/2020

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