MEDICARE: FAWCETT CENTER FOR DENTISTRY, PA

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	14301	TX

General Provider Information

NPI Number	:	1558363036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAWCETT CENTER FOR DENTISTRY, PA

Provider Business Mailing Address
First Line	:	13956 CUTTEN RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-2215
Country	:	US
Telephone Number	:	281-440-6648
Fax Number	:	281-440-4120

Provider Business Practice Location Address
First Line	:	13956 CUTTEN RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-2215
Country	:	US
Telephone Number	:	281-440-6648
Fax Number	:	281-440-4120

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WAYDE FAWCETT
Credential	:	DDS
Telephone Number	:	281-440-6648

Provider Enumeration Date	:	08/13/2005
Last Update Date	:	05/11/2008

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