MEDICARE: BAY OAKS PEDIATRIC DENTISTRY 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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1144956285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY OAKS PEDIATRIC DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	1919 LAKE WINDS DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-1710
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 CLEAR LAKE CITY BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77062-2102
Country	:	US
Telephone Number	:	281-480-8877
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SHERVIN AMINI
Credential	:
Telephone Number	:	713-465-8239

Provider Enumeration Date	:	07/30/2022
Last Update Date	:	07/31/2022

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