MEDICARE: TINY TEXANS GENERAL ANESTHESIA DENTISTRY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223P0221X	Pediatric Dentistry
2	1223G0001X	General Practice Dentistry
3	122300000X	Dentist

General Provider Information

NPI Number	:	1972307676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TINY TEXANS GENERAL ANESTHESIA DENTISTRY, PLLC

Provider Business Mailing Address
First Line	:	1220 CARAWAY CT STE 1050
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-5338
Country	:	US
Telephone Number	:	301-494-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 BINZ ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-7296
Country	:	US
Telephone Number	:	346-826-3899
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JEFF WHEELER
Credential	:
Telephone Number	:	301-494-3000

Provider Enumeration Date	:	04/02/2025
Last Update Date	:	04/29/2026

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