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General NPI Number Information
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NPI Number | 1316393655
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Entity Type | Organization
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Legal Business Name | CITY SMILES DENTAL
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Dates
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Enumeration Date | 05/05/2016
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Last Update Date | 05/05/2016
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Provider Practice Location Address
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Address Line | 14740 BARRYKNOLL LN SUITE 160
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City | HOUSTON
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State | TX
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Zip | 77079-2884
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Country | US
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Telephone | 281-589-6100
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Fax | 281-752-0256
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Provider Business Mailing Address
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Address Line | 14740 BARRYKNOLL LN SUITE 160
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City | HOUSTON
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State | TX
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Zip | 77079-2884
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Country | US
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Telephone | 281-589-6100
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Fax | 281-752-0256
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Authorized Official
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Title or Position | CEO
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Name | DR. GUSTAVO SALAS
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Credential | DDS MS
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Telephone | 281-589-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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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 |
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License Number State |
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