MEDICARE: SANTA MARIA RSVJR 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	:	1851067219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA MARIA RSVJR PLLC

Provider Business Mailing Address
First Line	:	6112 BELLAIRE BLVD STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4913
Country	:	US
Telephone Number	:	214-493-1216
Fax Number	:

Provider Business Practice Location Address
First Line	:	6112 BELLAIRE BLVD STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4913
Country	:	US
Telephone Number	:	214-493-1216
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	NINA ABTAHI
Credential	:
Telephone Number	:	214-493-1216

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	08/17/2021

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