MEDICARE: ASSOCIATES FOR DENTAL HEALTH, PLLC

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	1223E0200X	Endodontics
2	1223G0001X	General Practice Dentistry
3	1223P0221X	Pediatric Dentistry
4	1223P0300X	Periodontics
5	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
6	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	6626
7	122300000X	Dentist	6626	TX

General Provider Information

NPI Number	:	1760866420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATES FOR DENTAL HEALTH, PLLC

Provider Business Mailing Address
First Line	:	4701 AIRLINE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-3003
Country	:	US
Telephone Number	:	281-738-1579
Fax Number	:	713-490-8880

Provider Business Practice Location Address
First Line	:	4701 AIRLINE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-3003
Country	:	US
Telephone Number	:	281-738-1579
Fax Number	:	713-490-6464

Authorized Official
Title or Position	:	OWNER
Name	:	DONALD ANDRESS
Credential	:	DDS
Telephone Number	:	281-738-1579

Provider Enumeration Date	:	07/13/2015
Last Update Date	:	07/13/2015

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