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General NPI Number Information
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NPI Number | 1144585688
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Entity Type | Organization
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Legal Business Name | KATY SMILE DESIGN, PLLC
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 24207 KINGSLAND BOULEVARD
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City | KATY
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State | TX
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Zip | 77494
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Country | US
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Telephone | 281-396-4366
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Fax | 281-396-4367
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Provider Business Mailing Address
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Address Line | 24207 KINGSLAND BOULEVARD
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City | KATY
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State | TX
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Zip | 77494
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Country | US
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Telephone | 281-396-4366
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Fax | 281-396-4367
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | LAUREN SHEPARD
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Credential | D.D.S
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Telephone | 281-396-4366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 24019
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 16804
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License Number State | TX
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