MEDICARE: DR. ANDREW MARTIN BHAGYAM DDS, MD

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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	U4742	TX
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	39343	TX

General Provider Information

NPI Number	:	1073976890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW MARTIN BHAGYAM DDS, MD

Provider Business Mailing Address
First Line	:	11451 KATY FWY STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-0012
Country	:	US
Telephone Number	:	346-867-3139
Fax Number	:	346-406-1526

Provider Business Practice Location Address
First Line	:	11451 KATY FWY STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-0012
Country	:	US
Telephone Number	:	346-867-3139
Fax Number	:	346-406-1526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2016
Last Update Date	:	05/18/2026

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