MEDICARE: HOUSTON MINT DENTISTRY, 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1871146340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTON MINT DENTISTRY, PLLC

Provider Business Mailing Address
First Line	:	11811 NORTH FWY STE 600
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-3261
Country	:	US
Telephone Number	:	214-821-6468
Fax Number	:

Provider Business Practice Location Address
First Line	:	6640 CYPRESSWOOD DR STE 103
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-7738
Country	:	US
Telephone Number	:	214-821-6468
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	FIELD HARRISON
Credential	:
Telephone Number	:	214-821-6468

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	07/23/2019

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