MEDICARE: UNION 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1003249053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNION DENTAL PLLC

Provider Business Mailing Address
First Line	:	4654 HIGHWAY 6 N
Second Line	:	SUITE 401
City	:	HOUSTON
State	:	TX
Zip	:	77084-2868
Country	:	US
Telephone Number	:	832-683-4034
Fax Number	:	832-683-4782

Provider Business Practice Location Address
First Line	:	4654 HIGHWAY 6 NORTH
Second Line	:	SUITE 401
City	:	HOUSTON
State	:	TX
Zip	:	77084
Country	:	US
Telephone Number	:	832-683-4034
Fax Number	:	832-680-4782

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BORIS JESUS MALESPIN
Credential	:	DDS
Telephone Number	:	832-683-4034

Provider Enumeration Date	:	08/14/2013
Last Update Date	:	08/14/2013

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