MEDICARE: MLS DENTAL GROUP PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	122300000X	Dentist
2	1223E0200X	Endodontics
3	1223P0300X	Periodontics
4	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
5	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1669836912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MLS DENTAL GROUP PLLC

Provider Business Mailing Address
First Line	:	9180 BELLAIRE BLVD STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-4600
Country	:	US
Telephone Number	:	713-773-1300
Fax Number	:	713-773-3311

Provider Business Practice Location Address
First Line	:	9180 BELLAIRE BLVD STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-4600
Country	:	US
Telephone Number	:	713-773-1300
Fax Number	:	713-773-3311

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JESSICA SU
Credential	:
Telephone Number	:	713-773-1300

Provider Enumeration Date	:	04/12/2016
Last Update Date	:	04/09/2026

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