MEDICARE: AI TON 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	1223G0001X	General Practice Dentistry	33111	TX

General Provider Information

NPI Number	:	1437671989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AI TON DDS

Provider Business Mailing Address
First Line	:	3000 BISSONNET ST APT 6203
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-4088
Country	:	US
Telephone Number	:	940-224-2118
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 FOUNTAIN VIEW DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-3004
Country	:	US
Telephone Number	:	713-783-1095
Fax Number	:

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

Provider Enumeration Date	:	07/15/2017
Last Update Date	:	07/15/2017

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