MEDICARE: ALPHA DMD, 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

General Provider Information

NPI Number	:	1659019420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA DMD, PLLC

Provider Business Mailing Address
First Line	:	21003 HIGHLAND KNOLLS DR STE 100
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-1565
Country	:	US
Telephone Number	:	281-712-7271
Fax Number	:	832-321-4976

Provider Business Practice Location Address
First Line	:	21003 HIGHLAND KNOLLS DR STE 100
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-1565
Country	:	US
Telephone Number	:	281-712-7271
Fax Number	:	832-321-4976

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALETHEA KYPRIOTAKIS
Credential	:	DMD
Telephone Number	:	281-712-7271

Provider Enumeration Date	:	05/23/2022
Last Update Date	:	05/23/2022

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