Provider Demographics
NPI:1326875055
Name:BLEU PEDIATRIC DENTISTRY & ORTHODONTICS
Entity type:Organization
Organization Name:BLEU PEDIATRIC DENTISTRY & ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MINYUE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:832-764-8658
Mailing Address - Street 1:7311 JULIE POND LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-2887
Mailing Address - Country:US
Mailing Address - Phone:617-447-3885
Mailing Address - Fax:
Practice Address - Street 1:27214 KUYKENDAHL RD STE 200
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77375-3529
Practice Address - Country:US
Practice Address - Phone:832-764-8658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty