MEDICARE: JOHN D SMITH DDS & JOSEPH J CHEN DDS 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	12241	TX
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	21567	TX
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	11886	TX

General Provider Information

NPI Number	:	1518262112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN D SMITH DDS & JOSEPH J CHEN DDS INC

Provider Business Mailing Address
First Line	:	11455 FALLBROOK DR STE 302
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-4268
Country	:	US
Telephone Number	:	281-890-1158
Fax Number	:	281-890-0710

Provider Business Practice Location Address
First Line	:	11455 FALLBROOK DR STE 302
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-4268
Country	:	US
Telephone Number	:	281-890-1158
Fax Number	:	281-890-0710

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH J. CHEN
Credential	:	D.D.S.
Telephone Number	:	281-890-1158

Provider Enumeration Date	:	01/13/2011
Last Update Date	:	08/29/2011

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