MEDICARE: DALLAS CENTER FOR COSMETIC DENTISTRY PA

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	122300000X	Dentist

General Provider Information

NPI Number	:	1912074485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALLAS CENTER FOR COSMETIC DENTISTRY PA

Provider Business Mailing Address
First Line	:	6136 SHERRY LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-6301
Country	:	US
Telephone Number	:	214-692-1700
Fax Number	:	214-368-6546

Provider Business Practice Location Address
First Line	:	6136 SHERRY LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-6301
Country	:	US
Telephone Number	:	214-692-1700
Fax Number	:	214-368-6546

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES H ADDISON
Credential	:	DDS
Telephone Number	:	214-692-1700

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	03/14/2008

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