Healthcare Provider Details

I. General information

NPI: 1598480089
Provider Name (Legal Business Name): EXQUISITE DENTAL SMILES II PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 02/06/2023
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5815 GULF FWY STE 200
HOUSTON TX
77023-5364
US

IV. Provider business mailing address

22722 MOORE POINT LN
RICHMOND TX
77469-2452
US

V. Phone/Fax

Practice location:
  • Phone: 281-727-0051
  • Fax: 281-727-0052
Mailing address:
  • Phone: 713-732-8032
  • Fax: 832-553-2124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

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