MEDICARE: SW DENTAL CARE

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	14490	TX

General Provider Information

NPI Number	:	1962670273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SW DENTAL CARE

Provider Business Mailing Address
First Line	:	10815 BEECHNUT ST STE 131
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-4491
Country	:	US
Telephone Number	:	281-879-7749
Fax Number	:

Provider Business Practice Location Address
First Line	:	10815 BEECHNUT ST STE 131
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-4491
Country	:	US
Telephone Number	:	281-879-7749
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PHUONG NAM THI DO
Credential	:
Telephone Number	:	281-879-7749

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	02/20/2008

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Directions to “SW DENTAL CARE ” Practice Location

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