=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578964086
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MADE YA SMILE WEST EIGHT CROSSING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2014
-----------------------------------------------------
Last Update Date | 09/16/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9050 W SAM HOUSTON PKWY N STE 400
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77064-6307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-265-1111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1449 HIGHWAY 6 STE 320
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77478-5146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-265-1111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHAEL KESNER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 281-265-1111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------