MEDICARE: MRS. MARIBEL HARB 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	1223P0700X	Prosthodontics	21138	TX

General Provider Information

NPI Number	:	1750571386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIBEL HARB D.D.S.

Provider Business Mailing Address
First Line	:	3055 SAGE RD
Second Line	:	# 190
City	:	HOUSTON
State	:	TX
Zip	:	77056-6303
Country	:	US
Telephone Number	:	713-623-6622
Fax Number	:	713-623-6688

Provider Business Practice Location Address
First Line	:	3055 SAGE RD
Second Line	:	# 190
City	:	HOUSTON
State	:	TX
Zip	:	77056-6303
Country	:	US
Telephone Number	:	713-623-6622
Fax Number	:	713-623-6688

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

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	07/30/2007

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