MEDICARE: CRYPTODENTAL 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	:	1093607350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYPTODENTAL PLLC

Provider Business Mailing Address
First Line	:	5264 BEECHNUT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-1302
Country	:	US
Telephone Number	:	713-981-4600
Fax Number	:

Provider Business Practice Location Address
First Line	:	5264 BEECHNUT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-1302
Country	:	US
Telephone Number	:	713-981-4600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TONY PORTELLES
Credential	:	DMD
Telephone Number	:	713-281-5523

Provider Enumeration Date	:	07/18/2025
Last Update Date	:	05/22/2026

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Directions to “CRYPTODENTAL PLLC ” Practice Location

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