MEDICARE: GULFTON DENTAL 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
1	1223G0001X	General Practice Dentistry	20832	TX

General Provider Information

NPI Number	:	1982032348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULFTON DENTAL PA

Provider Business Mailing Address
First Line	:	5608 GULFTON ST STE D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-2700
Country	:	US
Telephone Number	:	713-665-2483
Fax Number	:	713-665-0120

Provider Business Practice Location Address
First Line	:	5608 GULFTON ST STE D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-2700
Country	:	US
Telephone Number	:	713-665-2483
Fax Number	:	713-665-0120

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. PATRICIA C RIANO
Credential	:	D.D.S
Telephone Number	:	713-665-2483

Provider Enumeration Date	:	10/23/2013
Last Update Date	:	10/23/2013

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