MEDICARE: MILES OF SMILES INC

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	17899	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083983175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILES OF SMILES INC

Provider Business Mailing Address
First Line	:	3055 SAGE RD
Second Line	:	#190
City	:	HOUSTON
State	:	TX
Zip	:	77056-6303
Country	:	US
Telephone Number	:	713-623-6622
Fax Number	:	713-623-6622

Provider Business Practice Location Address
First Line	:	3055 SAGE RD
Second Line	:	#190
City	:	HOUSTON
State	:	TX
Zip	:	77056-6303
Country	:	US
Telephone Number	:	713-623-6622
Fax Number	:	713-623-6622

Authorized Official
Title or Position	:	OWNER
Name	:	MS. LOMA HAMOUIE
Credential	:
Telephone Number	:	713-623-6622

Provider Enumeration Date	:	12/20/2011
Last Update Date	:	12/20/2011

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Directions to “MILES OF SMILES INC ” Practice Location

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