Provider Demographics
NPI:1750005518
Name:DENTALSURE, PLLC
Entity type:Organization
Organization Name:DENTALSURE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:PHO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-856-0626
Mailing Address - Street 1:16010 SANDY RING CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-3899
Mailing Address - Country:US
Mailing Address - Phone:832-856-0626
Mailing Address - Fax:
Practice Address - Street 1:2681 WILCREST DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-3211
Practice Address - Country:US
Practice Address - Phone:713-787-5434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty