MEDICARE: DR. DAVID WAYNE TEASDALE D.D.S.

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	13284	TX

General Provider Information

NPI Number	:	1972669851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID WAYNE TEASDALE D.D.S.

Provider Business Mailing Address
First Line	:	8801 GAYLORD ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2990
Country	:	US
Telephone Number	:	713-461-4737
Fax Number	:	713-464-0304

Provider Business Practice Location Address
First Line	:	8801 GAYLORD ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2990
Country	:	US
Telephone Number	:	713-461-4737
Fax Number	:	713-464-0304

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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