MEDICARE: MI FAMILIA DENTAL 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1083208284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MI FAMILIA DENTAL PLLC

Provider Business Mailing Address
First Line	:	2421 ALDINE MAIL RTE STE D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77039-5530
Country	:	US
Telephone Number	:	281-617-8960
Fax Number	:	281-617-7012

Provider Business Practice Location Address
First Line	:	2421 ALDINE MAIL RTE STE D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77039-5530
Country	:	US
Telephone Number	:	281-617-8960
Fax Number	:	281-617-7012

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JAIME MUNOZ
Credential	:
Telephone Number	:	832-495-3213

Provider Enumeration Date	:	02/28/2021
Last Update Date	:	02/28/2021

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