MEDICARE: KALYOPY N. EMMANOUIL D.D.S

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	122300000X	Dentist	31243	TX

General Provider Information

NPI Number	:	1396121489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALYOPY N. EMMANOUIL D.D.S

Provider Business Mailing Address
First Line	:	1470 SPRINGROCK LN # II
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-4375
Country	:	US
Telephone Number	:	281-701-6074
Fax Number	:

Provider Business Practice Location Address
First Line	:	1470 SPRINGROCK LN # II
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-4375
Country	:	US
Telephone Number	:	281-701-6074
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2015
Last Update Date	:	07/31/2015

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