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NPI Code Detail

MEDICARE: BELLAIRE PERIOCOSMETIC DENTAL PLLC

MEDICARE: BELLAIRE PERIOCOSMETIC 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
11223P0300XPeriodontics

General Provider Information

NPI Number : 1326669193
Entity Type Code : Organization
Provider Name (Legal Business Name) : BELLAIRE PERIOCOSMETIC DENTAL PLLC
Provider Business Mailing Address
First Line : PO BOX 17029
Second Line :
City : SUGAR LAND
State : TX
Zip : 77496-7029
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9889 BELLAIRE BLVD STE 322
Second Line :
City : HOUSTON
State : TX
Zip : 77036-3468
Country : US
Telephone Number : 713-995-0086
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : ZHIJIAN CHEN
Credential : DDS
Telephone Number : 832-620-9131
Provider Enumeration Date : 05/02/2020
Last Update Date : 05/02/2020

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Directions to “BELLAIRE PERIOCOSMETIC DENTAL PLLC ” Practice Location

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