MEDICARE: LAWNDALE DENTAL, PA

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G60235-02	OTHER	TX	CHIPS

General Provider Information

NPI Number	:	1659432300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWNDALE DENTAL, PA

Provider Business Mailing Address
First Line	:	7062 LAWNDALE ST
Second Line	:	STE B
City	:	HOUSTON
State	:	TX
Zip	:	77023-4211
Country	:	US
Telephone Number	:	713-923-4333
Fax Number	:	713-923-5977

Provider Business Practice Location Address
First Line	:	7062 LAWNDALE ST
Second Line	:	STE B
City	:	HOUSTON
State	:	TX
Zip	:	77023-4211
Country	:	US
Telephone Number	:	713-923-4333
Fax Number	:	713-923-5977

Authorized Official
Title or Position	:	DENTIST CEO
Name	:	DR. SAMI THALJI
Credential	:	D.D.S.
Telephone Number	:	713-923-4333

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	08/22/2020

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Directions to “LAWNDALE DENTAL, PA ” Practice Location

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