MEDICARE: ESTEEM DENTAL STONE PARK

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	25994	TX

General Provider Information

NPI Number	:	1477981876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESTEEM DENTAL STONE PARK

Provider Business Mailing Address
First Line	:	PO BOX 84703
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-0010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5810 E SAM HOUSTON PKWY N
Second Line	:	STE L
City	:	HOUSTON
State	:	TX
Zip	:	77049-2528
Country	:	US
Telephone Number	:	281-459-1541
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSHUA KIM
Credential	:	D.D.S
Telephone Number	:	213-505-4605

Provider Enumeration Date	:	10/22/2013
Last Update Date	:	10/22/2013

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Directions to “ESTEEM DENTAL STONE PARK ” Practice Location

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