MEDICARE: DR. MERCEDES TATLONGHARI SULIT DMD

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	12317686	TX

General Provider Information

NPI Number	:	1992810535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MERCEDES TATLONGHARI SULIT DMD

Provider Business Mailing Address
First Line	:	2646 SOUTH LOOP WEST
Second Line	:	SUITE 575
City	:	HOUSTON
State	:	TX
Zip	:	77054
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2646 SOUTH LOOP WEST
Second Line	:	SUITE 575
City	:	HOUSTON
State	:	TX
Zip	:	77054
Country	:	US
Telephone Number	:	713-838-7019
Fax Number	:	713-838-7026

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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