MEDICARE: FAMILY FIRST DENTAL, 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	122300000X	Dentist	18575	TX

General Provider Information

NPI Number	:	1669762696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY FIRST DENTAL, PLLC

Provider Business Mailing Address
First Line	:	15951 FM 529 RD
Second Line	:	SUITE 140
City	:	HOUSTON
State	:	TX
Zip	:	77095-2696
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15951 FM 529 RD
Second Line	:	SUITE 140
City	:	HOUSTON
State	:	TX
Zip	:	77095-2696
Country	:	US
Telephone Number	:	281-866-5986
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ANDREAS XYDAS
Credential	:	D.D.S.
Telephone Number	:	281-866-5986

Provider Enumeration Date	:	04/11/2011
Last Update Date	:	04/11/2011

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