MEDICARE: DR. RONNIE ELMORE 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	1223G0001X	General Practice Dentistry	12963	TX

General Provider Information

NPI Number	:	1790758159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONNIE ELMORE DDS

Provider Business Mailing Address
First Line	:	PO BOX 38578
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77238-8578
Country	:	US
Telephone Number	:	281-591-0401
Fax Number	:	281-591-0185

Provider Business Practice Location Address
First Line	:	1389 WEST GULF BANK
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77088-3652
Country	:	US
Telephone Number	:	281-591-0401
Fax Number	:	281-591-0185

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	06/18/2008

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