MEDICARE: DPS MANAGEMENT LLC

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

General Provider Information

NPI Number	:	1568143907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DPS MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	PO BOX 70887
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44190-0887
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6421 WEST RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77086-3253
Country	:	US
Telephone Number	:	832-694-4420
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR CREDENTIALING & ENROLLMENT
Name	:	MICHELLE JACOMINO-BARNES
Credential	:
Telephone Number	:	813-270-9497

Provider Enumeration Date	:	07/28/2023
Last Update Date	:	09/14/2023

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Directions to “DPS MANAGEMENT LLC ” Practice Location

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