MEDICARE: RADIANT SMILES DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305S00000X	Point of Service	25737	TX

General Provider Information

NPI Number	:	1013275783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIANT SMILES DENTAL

Provider Business Mailing Address
First Line	:	10701 W BELLFORT ST
Second Line	:	SUITE 194
City	:	HOUSTON
State	:	TX
Zip	:	77099-4748
Country	:	US
Telephone Number	:	281-530-2676
Fax Number	:

Provider Business Practice Location Address
First Line	:	10701 W BELLFORT ST
Second Line	:	SUITE 194
City	:	HOUSTON
State	:	TX
Zip	:	77099-4748
Country	:	US
Telephone Number	:	281-530-2676
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AKUDO L EKWEM
Credential	:
Telephone Number	:	281-530-2676

Provider Enumeration Date	:	05/01/2012
Last Update Date	:	05/01/2012

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Directions to “RADIANT SMILES DENTAL ” Practice Location

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