MEDICARE: A&A DENTAL KIDS, PLLC

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	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578228268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A&A DENTAL KIDS, PLLC

Provider Business Mailing Address
First Line	:	3201 BROADWAY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77017-2320
Country	:	US
Telephone Number	:	713-643-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 BROADWAY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77017-2320
Country	:	US
Telephone Number	:	713-643-2500
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AIDE JACIVE RUBIO-SANCHEZ
Credential	:	DDS
Telephone Number	:	713-643-2500

Provider Enumeration Date	:	11/08/2021
Last Update Date	:	11/08/2021

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