MEDICARE: SHINE PEARL DENTAL AND ASSOCIATES 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	261QD0000X	Dental Clinic/Center
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1891422309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHINE PEARL DENTAL AND ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	2500 S MILLBEND DR APT 4105
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-1889
Country	:	US
Telephone Number	:	267-368-0366
Fax Number	:

Provider Business Practice Location Address
First Line	:	2445 FULTON ST STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-7837
Country	:	US
Telephone Number	:	713-225-2266
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. MINH CHAU PHAM
Credential	:	DMD
Telephone Number	:	713-225-2266

Provider Enumeration Date	:	08/04/2022
Last Update Date	:	08/10/2022

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