MEDICARE: A & A DENTAL CLINIC, P.C.

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	1223P0700X	Prosthodontics	16936	TX
2	122300000X	Dentist	16936	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16939	OTHER	TX	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	G60166-01	OTHER	TX	PROVIDER ID

General Provider Information

NPI Number	:	1578739066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A & A DENTAL CLINIC, P.C.

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	:	713-643-2797

Provider Business Practice Location Address
First Line	:	3201 BROADWAY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77017
Country	:	US
Telephone Number	:	713-643-2500
Fax Number	:	713-643-2797

Authorized Official
Title or Position	:	PROSTHODONTICS
Name	:	DR. ANGEL DAVID SANCHEZ
Credential	:	D.D.S.
Telephone Number	:	713-643-2500

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	02/03/2009

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