MEDICARE: WILLIS J PUMPHREY JR. D.D.S. 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	13017	TX

General Provider Information

NPI Number	:	1548315591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIS J PUMPHREY JR. D.D.S. P.A.

Provider Business Mailing Address
First Line	:	4126 SOUTHWEST FWY
Second Line	:	SUITE #1610
City	:	HOUSTON
State	:	TX
Zip	:	77027-7310
Country	:	US
Telephone Number	:	713-777-6453
Fax Number	:

Provider Business Practice Location Address
First Line	:	4126 SOUTHWEST FWY
Second Line	:	SUITE #1610
City	:	HOUSTON
State	:	TX
Zip	:	77027-7310
Country	:	US
Telephone Number	:	713-777-6453
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. WILLIS J PUMPHREY JR.
Credential	:	D.D.S.
Telephone Number	:	713-777-6453

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	06/18/2008

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