MEDICARE: MILAD HOSSEINI BALAI

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	122300000X	Dentist	39549	TX

General Provider Information

NPI Number	:	1922782572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILAD HOSSEINI BALAI

Provider Business Mailing Address
First Line	:	4211 PURDUE ST STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-1041
Country	:	US
Telephone Number	:	281-736-6964
Fax Number	:

Provider Business Practice Location Address
First Line	:	4211 PURDUE ST STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-1041
Country	:	US
Telephone Number	:	281-736-6964
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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Directions to “ MILAD HOSSEINI BALAI ” Practice Location

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