MEDICARE: DR. SCTRAG DERMENDJIAN D.D.S.

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	26070	TX

General Provider Information

NPI Number	:	1629373691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCTRAG DERMENDJIAN D.D.S.

Provider Business Mailing Address
First Line	:	26615 OAK RIDGE DR
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-1968
Country	:	US
Telephone Number	:	281-296-8600
Fax Number	:	281-296-9509

Provider Business Practice Location Address
First Line	:	26615 OAK RIDGE DR
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-1968
Country	:	US
Telephone Number	:	281-296-8600
Fax Number	:	281-296-9509

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2011
Last Update Date	:	01/21/2011

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Directions to “ DR. SCTRAG DERMENDJIAN D.D.S.” Practice Location

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