MEDICARE: VALENTINI GRAS 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	1223P0300X	Periodontics

General Provider Information

NPI Number	:	1538879408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALENTINI GRAS DENTAL PLLC

Provider Business Mailing Address
First Line	:	650 HEIGHTS BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-2524
Country	:	US
Telephone Number	:	281-974-4086
Fax Number	:

Provider Business Practice Location Address
First Line	:	4718 INGERSOLL ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-6602
Country	:	US
Telephone Number	:	832-763-3185
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MISS YASMIN MEDELLIN
Credential	:	RDA
Telephone Number	:	832-763-3185

Provider Enumeration Date	:	12/01/2022
Last Update Date	:	12/07/2022

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