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General NPI Number Information
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NPI Number | 1538394994
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Entity Type | Organization
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Legal Business Name | BAYOU CITY SMILES
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Dates
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Enumeration Date | 05/28/2009
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Last Update Date | 05/28/2009
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Provider Practice Location Address
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Address Line | 4000 WASHINGTON AVENUE SUITE 201
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City | HOUSTON
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State | TX
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Zip | 77007
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Country | US
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Telephone | 713-518-1411
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Fax | 713-802-9495
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Provider Business Mailing Address
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Address Line | 4000 WASHINGTON AVENUE SUITE 201
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City | HOUSTON
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State | TX
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Zip | 77007
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Country | US
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Telephone | 713-518-1411
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Fax | 713-802-9495
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Authorized Official
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Title or Position | DENTIST
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Name | RAYMUND MARCUS DEGUZMAN
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Credential | DMD
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Telephone | 713-518-1411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 20348
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License Number State | TX
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