MEDICARE: URBN DENTAL MEYERLAND 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	:	1649033234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URBN DENTAL MEYERLAND PLLC

Provider Business Mailing Address
First Line	:	450 MEYERLAND PLAZA MALL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-1613
Country	:	US
Telephone Number	:	601-862-1085
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 MEYERLAND PLAZA MALL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-1613
Country	:	US
Telephone Number	:	601-862-1085
Fax Number	:

Authorized Official
Title or Position	:	DENTIST OWNER
Name	:	DR. JIMAN NELSON
Credential	:	DMD
Telephone Number	:	601-862-1085

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	01/31/2026

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