MEDICARE: DR. JANUS JEAN DE CUNAE DDS

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	DD2693	NM
2	1223G0001X	General Practice Dentistry	DD2693	NM
3	1223G0001X	General Practice Dentistry	24344	TX

General Provider Information

NPI Number	:	1760676258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANUS JEAN DE CUNAE DDS

Provider Business Mailing Address
First Line	:	2350 ATASCOCITA RD
Second Line	:	LYCHNER UNIT, DENTAL DEPARTMENT
City	:	HUMBLE
State	:	TX
Zip	:	77396-3503
Country	:	US
Telephone Number	:	281-454-5036
Fax Number	:

Provider Business Practice Location Address
First Line	:	2350 ATASCOCITA RD
Second Line	:	LYCHNER UNIT, DENTAL DEPARTMENT
City	:	HUMBLE
State	:	TX
Zip	:	77396-3503
Country	:	US
Telephone Number	:	281-454-5036
Fax Number	:

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

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	06/12/2023

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