MEDICARE: KA SMILE PLUS

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	30385	TX

General Provider Information

NPI Number	:	1639610181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KA SMILE PLUS

Provider Business Mailing Address
First Line	:	617 K AVE STE 300
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-8533
Country	:	US
Telephone Number	:	972-372-9170
Fax Number	:	972-379-8115

Provider Business Practice Location Address
First Line	:	617 K AVE STE 300
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-8533
Country	:	US
Telephone Number	:	972-372-9170
Fax Number	:	972-379-8115

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DR. JESSICA LIEN
Credential	:	DDS
Telephone Number	:	214-893-2735

Provider Enumeration Date	:	03/16/2017
Last Update Date	:	03/16/2017

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Directions to “KA SMILE PLUS ” Practice Location

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