MEDICARE: POLISH DENTISTRY, P.A.

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

General Provider Information

NPI Number	:	1518560291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POLISH DENTISTRY, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 270155
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77277-0155
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 WESTHEIMER RD STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-3221
Country	:	US
Telephone Number	:	713-942-0101
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	BRIANNE E TALAMANTEZ
Credential	:
Telephone Number	:	713-523-9655

Provider Enumeration Date	:	11/17/2020
Last Update Date	:	10/12/2022

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Directions to “POLISH DENTISTRY, P.A. ” Practice Location

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