MEDICARE: TMD CENTER, INC.

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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1558404731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TMD CENTER, INC.

Provider Business Mailing Address
First Line	:	7111 HARWIN DR
Second Line	:	SUITE 252
City	:	HOUSTON
State	:	TX
Zip	:	77036-2129
Country	:	US
Telephone Number	:	713-334-6427
Fax Number	:	713-914-0050

Provider Business Practice Location Address
First Line	:	7111 HARWIN DR
Second Line	:	SUITE 252
City	:	HOUSTON
State	:	TX
Zip	:	77036-2129
Country	:	US
Telephone Number	:	713-334-6427
Fax Number	:	713-914-0050

Authorized Official
Title or Position	:	MANAGER
Name	:	HANH NGUYEN
Credential	:
Telephone Number	:	832-724-7201

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	08/22/2020

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