MEDICARE: TRINITY SPRING 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	122300000X	Dentist
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1003443284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY SPRING DENTAL PLLC

Provider Business Mailing Address
First Line	:	507 N SAM HOUSTON PKWY E STE 565
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-4021
Country	:	US
Telephone Number	:	832-648-7632
Fax Number	:

Provider Business Practice Location Address
First Line	:	5240 FM 2920 RD STE 400
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-3003
Country	:	US
Telephone Number	:	832-648-7632
Fax Number	:	832-532-1904

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	RUBEN LOPEZ
Credential	:	DO
Telephone Number	:	832-648-7632

Provider Enumeration Date	:	03/26/2020
Last Update Date	:	10/06/2020

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