MEDICARE: JAMBOREE DENTISTRY VI PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223D0001X	Public Health Dentistry
2	122300000X	Dentist
3	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1790240794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMBOREE DENTISTRY VI PLLC

Provider Business Mailing Address
First Line	:	6715 BISSONNET ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-6129
Country	:	US
Telephone Number	:	832-930-7850
Fax Number	:	832-930-7851

Provider Business Practice Location Address
First Line	:	6715 BISSONNET ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-6129
Country	:	US
Telephone Number	:	832-930-7850
Fax Number	:	832-930-7851

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. JAMES T SPIGER
Credential	:	DMD
Telephone Number	:	832-930-7850

Provider Enumeration Date	:	02/04/2019
Last Update Date	:	02/04/2019

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