MEDICARE: CARE FOR KIDS OF TEXAS, 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	123G0001X	TX
2	1223P0221X	Pediatric Dentistry	1223P0221X	TX
3	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	1223X0400X	TX
4	126800000X	Dental Assistant	126800000X	TX
5	122300000X	Dentist	12300000X	TX

General Provider Information

NPI Number	:	1972749703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE FOR KIDS OF TEXAS, PLLC

Provider Business Mailing Address
First Line	:	3949 FREDERICKSBURG RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-3231
Country	:	US
Telephone Number	:	210-785-8555
Fax Number	:	480-385-2397

Provider Business Practice Location Address
First Line	:	3949 FREDERICKSBURG RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-3231
Country	:	US
Telephone Number	:	210-785-8555
Fax Number	:	480-385-2397

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EMERICO GOMEZ JR.
Credential	:	DDS
Telephone Number	:	602-400-3542

Provider Enumeration Date	:	12/29/2008
Last Update Date	:	12/29/2008

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