MEDICARE: MARWA KHARBOUTLI DMD

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	40198	TX
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	40198	TX

General Provider Information

NPI Number	:	1912777004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARWA KHARBOUTLI DMD

Provider Business Mailing Address
First Line	:	1046 MEMORIAL VILLAGE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-4454
Country	:	US
Telephone Number	:	281-818-9351
Fax Number	:

Provider Business Practice Location Address
First Line	:	1046 MEMORIAL VILLAGE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-4454
Country	:	US
Telephone Number	:	281-818-9351
Fax Number	:

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

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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Directions to “ MARWA KHARBOUTLI DMD” Practice Location

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