MEDICARE: S & S PARKER DENTAL,PC

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	23096	TX

General Provider Information

NPI Number	:	1659666246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S & S PARKER DENTAL,PC

Provider Business Mailing Address
First Line	:	7151 PARKER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016-3363
Country	:	US
Telephone Number	:	713-633-3130
Fax Number	:	713-633-4730

Provider Business Practice Location Address
First Line	:	7151 PARKER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016-3363
Country	:	US
Telephone Number	:	713-633-3130
Fax Number	:	713-633-4730

Authorized Official
Title or Position	:	SUPERVISOSR
Name	:	MR. SEAN DOULATSHAHI
Credential	:
Telephone Number	:	281-260-7773

Provider Enumeration Date	:	06/13/2011
Last Update Date	:	06/13/2011

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