MEDICARE: ATASCOCITA CONTEMPORARY DENTISTRY AND ORTHODONTICS PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14346842	OTHER		CAQH

General Provider Information

NPI Number	:	1952934176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATASCOCITA CONTEMPORARY DENTISTRY AND ORTHODONTICS PC

Provider Business Mailing Address
First Line	:	134 VINTAGE PARK BLVD STE ABOX14
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-3998
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6730 ATASCOCITA RD STE 111
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-1995
Country	:	US
Telephone Number	:	281-359-5551
Fax Number	:	281-359-5516

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	SHUNDA THOMPSON
Credential	:	DDS
Telephone Number	:	281-359-5551

Provider Enumeration Date	:	02/17/2020
Last Update Date	:	02/17/2020

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