MEDICARE: DENTISTS OF FORT BEND, 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	122300000X	Dentist

General Provider Information

NPI Number	:	1659882611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTISTS OF FORT BEND, PC

Provider Business Mailing Address
First Line	:	17000 RED HILL AVE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614-5626
Country	:	US
Telephone Number	:	714-845-8500
Fax Number	:	303-952-0892

Provider Business Practice Location Address
First Line	:	10177 W GRAND PKWY S STE 103
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-8643
Country	:	US
Telephone Number	:	346-702-3085
Fax Number	:	346-702-3085

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN S BARNES
Credential	:	DDS
Telephone Number	:	346-702-3085

Provider Enumeration Date	:	10/18/2017
Last Update Date	:	10/18/2017

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