MEDICARE: GULF FAMILY 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	19896	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669761425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF FAMILY DENTAL PC

Provider Business Mailing Address
First Line	:	4023 GULF ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-4723
Country	:	US
Telephone Number	:	713-645-8822
Fax Number	:	713-649-6023

Provider Business Practice Location Address
First Line	:	4023 GULF ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-4723
Country	:	US
Telephone Number	:	713-645-8822
Fax Number	:	713-649-6023

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ABDOUL R KORONI
Credential	:	DDS
Telephone Number	:	713-645-8822

Provider Enumeration Date	:	04/01/2011
Last Update Date	:	04/01/2011

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Directions to “GULF FAMILY DENTAL PC ” Practice Location

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