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NPI Code Detail

MEDICARE: MIDTOWN MTD LLC

MEDICARE: MIDTOWN MTD LLC
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
11223P0700XProsthodontics18415TX

General Provider Information

NPI Number : 1881133700
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDTOWN MTD LLC
Provider Business Mailing Address
First Line : 315 WESTHEIMER RD
Second Line :
City : HOUSTON
State : TX
Zip : 77006-3129
Country : US
Telephone Number : 713-322-6666
Fax Number :
Provider Business Practice Location Address
First Line : 315 WESTHEIMER RD
Second Line :
City : HOUSTON
State : TX
Zip : 77006-3129
Country : US
Telephone Number : 713-322-6666
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JONATHAN PENCHAS
Credential : DDS
Telephone Number : 713-322-6666
Provider Enumeration Date : 02/13/2017
Last Update Date : 02/13/2017

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