MEDICARE: DINODENTAL, PLLC

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	27877	TX
2	1223G0001X	General Practice Dentistry	27213	TX

General Provider Information

NPI Number	:	1952747776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DINODENTAL, PLLC

Provider Business Mailing Address
First Line	:	6421 W 43RD ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77092-4005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6421 W 43RD ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77092-4005
Country	:	US
Telephone Number	:	402-321-9054
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DR. PUKAR B RAJBHANDARI
Credential	:	D.D.S.
Telephone Number	:	402-321-9054

Provider Enumeration Date	:	05/20/2013
Last Update Date	:	05/20/2013

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