MEDICARE: DR. MICHAEL RONNIE NUGENT DDS

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	22464	TX

General Provider Information

NPI Number	:	1396853875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL RONNIE NUGENT DDS

Provider Business Mailing Address
First Line	:	3421 BURKE RD STE A
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-1800
Country	:	US
Telephone Number	:	713-941-8261
Fax Number	:	713-941-4766

Provider Business Practice Location Address
First Line	:	3421 BURKE RD STE A
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-1800
Country	:	US
Telephone Number	:	713-941-8261
Fax Number	:	713-941-4766

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

Provider Enumeration Date	:	08/26/2006
Last Update Date	:	07/15/2009

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