MEDICARE: AC SMILES DENTAL MANAGEMENT LLC

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	261QD0000X	Dental Clinic/Center

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	:	1821573411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AC SMILES DENTAL MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	11360 BELLAIRE BLVD STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-2532
Country	:	US
Telephone Number	:	832-617-8518
Fax Number	:

Provider Business Practice Location Address
First Line	:	11360 BELLAIRE BLVD STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-2532
Country	:	US
Telephone Number	:	832-617-8518
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANDY KOU
Credential	:
Telephone Number	:	281-550-5757

Provider Enumeration Date	:	09/28/2018
Last Update Date	:	11/20/2018

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