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General NPI Number Information
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NPI Number | 1992184105
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Entity Type | Organization
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Legal Business Name | MARVELOUS SMILES, LLC
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 1220 QUITMAN ST
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City | HOUSTON
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State | TX
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Zip | 77009-7833
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Country | US
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Telephone | 713-226-7050
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Fax | 713-226-7046
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Provider Business Mailing Address
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Address Line | 1220 QUITMAN ST
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City | HOUSTON
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State | TX
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Zip | 77009-7833
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Country | US
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Telephone | 713-226-7050
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Fax | 713-226-7046
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Authorized Official
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Title or Position | MANAGER
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Name | CHERIE TURKS
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Credential |
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Telephone | 713-476-2527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12238
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 13973
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License Number State | TX
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