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NPI Code Detail

MEDICARE: JONATHAN PENCHAS D.M.D.,M.ED., PA.

MEDICARE: JONATHAN PENCHAS D.M.D.,M.ED., PA.
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
11223P0700XProsthodontics18415TX

General Provider Information

NPI Number : 1972558906
Entity Type Code : Organization
Provider Name (Legal Business Name) : JONATHAN PENCHAS D.M.D.,M.ED., PA.
Provider Business Mailing Address
First Line : 315 WESTHEIMER RD
Second Line :
City : HOUSTON
State : TX
Zip : 77006-3129
Country : US
Telephone Number : 713-807-9877
Fax Number : 713-807-0501
Provider Business Practice Location Address
First Line : 315 WESTHEIMER RD
Second Line :
City : HOUSTON
State : TX
Zip : 77006-3129
Country : US
Telephone Number : 713-807-9877
Fax Number : 713-807-0501
Authorized Official
Title or Position : OWNER
Name : DR. JONATHAN PENCHAS
Credential : D.M.D., M.ED., PA.
Telephone Number : 713-807-9877
Provider Enumeration Date : 05/25/2006
Last Update Date : 08/11/2008

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