MEDICARE: NE HOUSTON 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	261QM1300X	Multi-Specialty Clinic/Center
2	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1417811076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NE HOUSTON DENTAL PLLC

Provider Business Mailing Address
First Line	:	169 MADISON AVE STE 38532
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-5101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 TIDWELL RD STE D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77093-6830
Country	:	US
Telephone Number	:	713-643-3684
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JASPAL SINGH
Credential	:
Telephone Number	:	307-303-3323

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “NE HOUSTON DENTAL PLLC ” Practice Location

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