MEDICARE: DR. JESSICA INEZ MACPHERSON 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	23377	TX

General Provider Information

NPI Number	:	1790981272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA INEZ MACPHERSON DDS

Provider Business Mailing Address
First Line	:	6300 WEST LOOP S STE 650
Second Line	:
City	:	BELLAIRE
State	:	TX
Zip	:	77401-2997
Country	:	US
Telephone Number	:	713-663-7960
Fax Number	:	713-349-8027

Provider Business Practice Location Address
First Line	:	20 E CROSSTIMBERS ST STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-6226
Country	:	US
Telephone Number	:	713-692-2400
Fax Number	:	713-692-4444

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

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	07/07/2011

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