MEDICARE: ABC DENTISTRY ROSENBERG, 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	1223G0001X	General Practice Dentistry	18929	TX

General Provider Information

NPI Number	:	1629240510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABC DENTISTRY ROSENBERG, PLLC

Provider Business Mailing Address
First Line	:	5110 AVENUE H STE D
Second Line	:
City	:	ROSENBERG
State	:	TX
Zip	:	77471-2014
Country	:	US
Telephone Number	:	281-593-3300
Fax Number	:	281-593-1616

Provider Business Practice Location Address
First Line	:	1214 E HOUSTON ST
Second Line	:	D
City	:	CLEVELAND
State	:	TX
Zip	:	77327-4754
Country	:	US
Telephone Number	:	281-593-3300
Fax Number	:	281-593-1616

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	IRAJ S JABBARY
Credential	:	DDS
Telephone Number	:	281-593-3300

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	03/31/2008

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