MEDICARE: MATTHEW DENNIS GEMP D.M.D.

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	1223P0700X	Prosthodontics	15416	TX

General Provider Information

NPI Number	:	1871682690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW DENNIS GEMP D.M.D.

Provider Business Mailing Address
First Line	:	2425 WEST LOOP S
Second Line	:	STE 333
City	:	HOUSTON
State	:	TX
Zip	:	77027-4205
Country	:	US
Telephone Number	:	713-960-9623
Fax Number	:	713-960-8682

Provider Business Practice Location Address
First Line	:	2425 WEST LOOP S
Second Line	:	STE 333
City	:	HOUSTON
State	:	TX
Zip	:	77027-4205
Country	:	US
Telephone Number	:	713-960-9623
Fax Number	:	713-960-8682

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	01/25/2016

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