MEDICARE: GOOD SHEPHERD DENTAL CLINIC INC

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	12948	TX

General Provider Information

NPI Number	:	1396886560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SHEPHERD DENTAL CLINIC INC

Provider Business Mailing Address
First Line	:	6220 DASHWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4214
Country	:	US
Telephone Number	:	713-771-8883
Fax Number	:	713-771-9993

Provider Business Practice Location Address
First Line	:	6220 DASHWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4214
Country	:	US
Telephone Number	:	713-771-8883
Fax Number	:	713-771-9993

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. TREVINA CHOY
Credential	:
Telephone Number	:	713-771-8883

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	08/22/2020

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