MEDICARE: DR. SERGIO FABIAN PALUK 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	21556	TX

General Provider Information

NPI Number	:	1750496519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SERGIO FABIAN PALUK D.D.S.

Provider Business Mailing Address
First Line	:	26615 OAK RIDGE DR
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-1968
Country	:	US
Telephone Number	:	281-296-8600
Fax Number	:	281-296-9509

Provider Business Practice Location Address
First Line	:	27866 INTERSTATE 45 N # C
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77385-8725
Country	:	US
Telephone Number	:	281-681-2700
Fax Number	:	281-296-0118

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2007

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