MEDICARE: SUMMIT DENTAL CENTER LP

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	17989	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871803130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT DENTAL CENTER LP

Provider Business Mailing Address
First Line	:	5225 KATY FWY STE 104
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-2268
Country	:	US
Telephone Number	:	832-673-0999
Fax Number	:	281-657-2406

Provider Business Practice Location Address
First Line	:	1914 GESSNER DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77080-6371
Country	:	US
Telephone Number	:	713-595-0999
Fax Number	:	281-657-2406

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ESSA A KAWAJA
Credential	:
Telephone Number	:	832-673-0999

Provider Enumeration Date	:	10/20/2010
Last Update Date	:	10/20/2010

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Directions to “SUMMIT DENTAL CENTER LP ” Practice Location

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