MEDICARE: MAHLMANN AND BORDERS ORTHODONTICS, 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1487127270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAHLMANN AND BORDERS ORTHODONTICS, PLLC

Provider Business Mailing Address
First Line	:	1310 THOMPSON RD
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-4245
Country	:	US
Telephone Number	:	281-342-6311
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 THOMPSON RD
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-4245
Country	:	US
Telephone Number	:	281-342-6311
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTICS
Name	:	DR. LEE ALLEN MAHLMANN
Credential	:	DDS, MS
Telephone Number	:	281-342-6311

Provider Enumeration Date	:	01/04/2019
Last Update Date	:	01/04/2019

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