=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619405255
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SARMIENTO MICROENDODONTICS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13050 LOUETTA RD STE 216
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77429-5208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-930-7870
-----------------------------------------------------
Fax | 832-698-2320
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13050 LOUETTA RD STE 216
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77429-5208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-930-7870
-----------------------------------------------------
Fax | 832-698-2320
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BERNARDO F SARMIENTO JR.
-----------------------------------------------------
Credential | DDS,MSD
-----------------------------------------------------
Telephone | 832-930-7870
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | 30839
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------