MEDICARE: VANESSA YVONNE POWELL

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	18430	TX

General Provider Information

NPI Number	:	1649779711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA YVONNE POWELL

Provider Business Mailing Address
First Line	:	9231 STELLA LINK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-3902
Country	:	US
Telephone Number	:	713-668-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	9231 STELLA LINK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-3902
Country	:	US
Telephone Number	:	713-668-4800
Fax Number	:

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

Provider Enumeration Date	:	02/05/2018
Last Update Date	:	02/05/2018

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