MEDICARE: BUNKER HILL PEDIATRIC DENTISTRY, PLLC

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	1223P0221X	Pediatric Dentistry	22319	TX

General Provider Information

NPI Number	:	1447566203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUNKER HILL PEDIATRIC DENTISTRY, PLLC

Provider Business Mailing Address
First Line	:	9742 KATY FWY
Second Line	:	SUITE 500
City	:	HOUSTON
State	:	TX
Zip	:	77055-6218
Country	:	US
Telephone Number	:	713-464-5437
Fax Number	:	713-464-5438

Provider Business Practice Location Address
First Line	:	9742 KATY FWY
Second Line	:	SUITE 500
City	:	HOUSTON
State	:	TX
Zip	:	77055-6218
Country	:	US
Telephone Number	:	713-464-5437
Fax Number	:	713-464-5438

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LINH M LUU
Credential	:	D.D.S.
Telephone Number	:	713-464-5437

Provider Enumeration Date	:	08/31/2010
Last Update Date	:	08/31/2010

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