MEDICARE: SMILE RITE ORLANDO PLLC

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	122300000X	Dentist

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	:	1821406281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE RITE ORLANDO PLLC

Provider Business Mailing Address
First Line	:	7014 PETTIGREW DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-6646
Country	:	US
Telephone Number	:	713-972-4455
Fax Number	:

Provider Business Practice Location Address
First Line	:	3310 ORLANDO ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77093-4855
Country	:	US
Telephone Number	:	713-742-5020
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN NGUYEN
Credential	:	DDS
Telephone Number	:	713-972-4455

Provider Enumeration Date	:	07/30/2014
Last Update Date	:	01/11/2017

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