MEDICARE: DENTALSURE, 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	1223D0001X	Public Health Dentistry

General Provider Information

NPI Number	:	1750005518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTALSURE, PLLC

Provider Business Mailing Address
First Line	:	16010 SANDY RING CT
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77429-3899
Country	:	US
Telephone Number	:	832-856-0626
Fax Number	:

Provider Business Practice Location Address
First Line	:	2681 WILCREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-3211
Country	:	US
Telephone Number	:	713-787-5434
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. JIMMY D PHO
Credential	:	DDS
Telephone Number	:	832-856-0626

Provider Enumeration Date	:	09/26/2022
Last Update Date	:	09/26/2022

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