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NPI Code Detail

MEDICARE: EVEREST DENTAL, PA

MEDICARE: EVEREST DENTAL, PA
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
11223G0001XGeneral Practice Dentistry21221TX

General Provider Information

NPI Number : 1710008610
Entity Type Code : Organization
Provider Name (Legal Business Name) : EVEREST DENTAL, PA
Provider Business Mailing Address
First Line : 7312 LOUETTA RD
Second Line : B-119
City : SPRING
State : TX
Zip : 77379-6175
Country : US
Telephone Number : 281-376-1735
Fax Number :
Provider Business Practice Location Address
First Line : 7312 LOUETTA RD
Second Line : B-119
City : SPRING
State : TX
Zip : 77379-6175
Country : US
Telephone Number : 281-376-1735
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. LONG V DO
Credential : D.D.S
Telephone Number : 832-274-9062
Provider Enumeration Date : 04/02/2007
Last Update Date : 08/07/2007

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Directions to “EVEREST DENTAL, PA ” Practice Location

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