MEDICARE: JAWHEALTH DENTAL 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	122300000X	Dentist

General Provider Information

NPI Number	:	1538887336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAWHEALTH DENTAL PLLC,

Provider Business Mailing Address
First Line	:	5050 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-4522
Country	:	US
Telephone Number	:	281-440-0814
Fax Number	:	281-440-6130

Provider Business Practice Location Address
First Line	:	5050 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-4522
Country	:	US
Telephone Number	:	281-440-0814
Fax Number	:	281-440-6130

Authorized Official
Title or Position	:	PRESIDENT
Name	:	QUSSAY A ALJAWHAR
Credential	:
Telephone Number	:	614-622-6042

Provider Enumeration Date	:	08/17/2022
Last Update Date	:	08/17/2022

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