MEDICARE: JUSTINE MAY BIELZA JIMENEZ DDS

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	1223G0001X	General Practice Dentistry	32693	TX

General Provider Information

NPI Number	:	1497100960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTINE MAY BIELZA JIMENEZ DDS

Provider Business Mailing Address
First Line	:	8514 GREEN PASEO PL
Second Line	:
City	:	ROSENBERG
State	:	TX
Zip	:	77469-2347
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4605 WILMINGTON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77051-3333
Country	:	US
Telephone Number	:	832-395-0054
Fax Number	:

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

Provider Enumeration Date	:	05/03/2016
Last Update Date	:	07/01/2022

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