MEDICARE: DR. ELDRIDGE F. DORSEY II D.D.S.

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	1223P0221X	Pediatric Dentistry	10504	TX

General Provider Information

NPI Number	:	1790991198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELDRIDGE F. DORSEY II D.D.S.

Provider Business Mailing Address
First Line	:	6962 BELLFORT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-5904
Country	:	US
Telephone Number	:	713-641-0857
Fax Number	:	713-641-1184

Provider Business Practice Location Address
First Line	:	6962 BELLFORT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-5904
Country	:	US
Telephone Number	:	713-641-0857
Fax Number	:	713-641-1184

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	12/03/2012

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