MEDICARE: SKY DENTAL, P.A.

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	23107	TX

General Provider Information

NPI Number	:	1972758605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKY DENTAL, P.A.

Provider Business Mailing Address
First Line	:	18700 W LAKE HOUSTON PKWY STE A107
Second Line	:
City	:	ATASCOCITA
State	:	TX
Zip	:	77346-3350
Country	:	US
Telephone Number	:	281-964-1001
Fax Number	:	281-852-6770

Provider Business Practice Location Address
First Line	:	18700 W LAKE HOUSTON PKWY STE A107
Second Line	:
City	:	ATASCOCITA
State	:	TX
Zip	:	77346-3350
Country	:	US
Telephone Number	:	281-964-1001
Fax Number	:	281-852-6770

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ABIR HUSSAMY KANJ
Credential	:	D.M.D.
Telephone Number	:	281-964-1001

Provider Enumeration Date	:	11/21/2008
Last Update Date	:	11/21/2008

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