MEDICARE: DR. MELISSA JEAN BRUNDRETT D.D.S.

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	16482	TX

General Provider Information

NPI Number	:	1689814691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA JEAN BRUNDRETT D.D.S.

Provider Business Mailing Address
First Line	:	13910 CHAMPION FOREST DR
Second Line	:	SUITE 205
City	:	HOUSTON
State	:	TX
Zip	:	77069-1882
Country	:	US
Telephone Number	:	281-893-1249
Fax Number	:	281-893-1937

Provider Business Practice Location Address
First Line	:	13910 CHAMPION FOREST DR
Second Line	:	SUITE 205
City	:	HOUSTON
State	:	TX
Zip	:	77069-1882
Country	:	US
Telephone Number	:	281-893-1249
Fax Number	:	281-893-1937

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2009
Last Update Date	:	03/03/2009

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