MEDICARE: MRS. CHRISTY STEWART KITTRELL RDH

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	124Q00000X	Dental Hygienist	15721	TX

General Provider Information

NPI Number	:	1992933949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTY STEWART KITTRELL RDH

Provider Business Mailing Address
First Line	:	9050 HIGHWAY 6
Second Line	:	SUITE 100
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-6055
Country	:	US
Telephone Number	:	281-778-0034
Fax Number	:	281-778-6152

Provider Business Practice Location Address
First Line	:	9050 HIGHWAY 6
Second Line	:	SUITE 100
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-6055
Country	:	US
Telephone Number	:	281-778-0034
Fax Number	:	281-778-6152

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

Provider Enumeration Date	:	06/29/2009
Last Update Date	:	06/29/2009

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