MEDICARE: PAMELA MEDICI

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	17974	TX
2	1223G0001X	General Practice Dentistry	17974	TX

General Provider Information

NPI Number	:	1912163908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA MEDICI

Provider Business Mailing Address
First Line	:	1810 S. BOWEN RD
Second Line	:	SUITE A
City	:	ARLINGTON
State	:	TX
Zip	:	76013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1810 S BOWEN RD
Second Line	:	SUITE A
City	:	PANTEGO
State	:	TX
Zip	:	76013-3340
Country	:	US
Telephone Number	:	817-274-8667
Fax Number	:

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

Provider Enumeration Date	:	07/30/2008
Last Update Date	:	07/30/2008

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Directions to “ PAMELA MEDICI ” Practice Location

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