MEDICARE: TEXAS DENTAL 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	1223G0001X	General Practice Dentistry	10849	TX

General Provider Information

NPI Number	:	1386865277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS DENTAL ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	2536 AMHERST ST
Second Line	:	STE. A
City	:	HOUSTON
State	:	TX
Zip	:	77005-3207
Country	:	US
Telephone Number	:	713-490-8880
Fax Number	:	713-490-6464

Provider Business Practice Location Address
First Line	:	4701 AIRLINE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-3003
Country	:	US
Telephone Number	:	713-691-5551
Fax Number	:	713-691-5552

Authorized Official
Title or Position	:	OWNER/GENERAL DENTIST
Name	:	DR. KENT E. ZIEGENBEIN
Credential	:
Telephone Number	:	713-490-8880

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	01/21/2011

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