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NPI Code Detail

MEDICARE: SOUTH TEXAS DENTAL ASSOCIATES, L.P.

MEDICARE: SOUTH TEXAS DENTAL ASSOCIATES, L.P.
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
11223G0001XGeneral Practice Dentistry16570TX

General Provider Information

NPI Number : 1497973895
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH TEXAS DENTAL ASSOCIATES, L.P.
Provider Business Mailing Address
First Line : 6300 WEST LOOP S STE 650
Second Line :
City : BELLAIRE
State : TX
Zip : 77401-2997
Country : US
Telephone Number : 713-663-7960
Fax Number : 713-349-8027
Provider Business Practice Location Address
First Line : 12052 EAST FWY
Second Line :
City : HOUSTON
State : TX
Zip : 77029-1916
Country : US
Telephone Number : 713-451-5700
Fax Number : 713-453-8911
Authorized Official
Title or Position : OFFICER/PARTNER
Name : BARRY JAMES GOMEL
Credential : DDS
Telephone Number : 713-663-7960
Provider Enumeration Date : 04/23/2007
Last Update Date : 07/07/2011

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Directions to “SOUTH TEXAS DENTAL ASSOCIATES, L.P. ” Practice Location

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