MEDICARE: DR. JAMES E. VICK DDS.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	7363	TX

General Provider Information

NPI Number	:	1548252059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES E. VICK DDS.

Provider Business Mailing Address
First Line	:	3703 PLUM GLEN CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77059-3748
Country	:	US
Telephone Number	:	281-480-8563
Fax Number	:

Provider Business Practice Location Address
First Line	:	3703 PLUM GLEN CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77059-3748
Country	:	US
Telephone Number	:	281-480-8563
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	07/08/2007

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