Healthcare Provider Details

I. General information

NPI: 1043019243
Provider Name (Legal Business Name): EXQUISITE DENTAL SMILES IV PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8845 WEST LOOP S STE C
HOUSTON TX
77096
US

IV. Provider business mailing address

8845 WEST LOOP S STE C
HOUSTON TX
77096
US

V. Phone/Fax

Practice location:
  • Phone: 713-732-8032
  • Fax: 346-226-0887
Mailing address:
  • Phone: 713-732-8032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MAHERIN MOMIN
Title or Position: OWNER/ PROVIDER
Credential:
Phone: 713-732-8032