MEDICARE: BLA 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1720384886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLA DENTAL PLLC

Provider Business Mailing Address
First Line	:	2145 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3103
Country	:	US
Telephone Number	:	281-880-8771
Fax Number	:

Provider Business Practice Location Address
First Line	:	2145 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3103
Country	:	US
Telephone Number	:	281-880-8771
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRYAN CHU
Credential	:	DDS
Telephone Number	:	281-880-8771

Provider Enumeration Date	:	02/07/2011
Last Update Date	:	02/07/2011

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Directions to “BLA DENTAL PLLC ” Practice Location

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