MEDICARE: KATY GENTLE SMILES, PLLC

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	122300000X	Dentist	24934	TX

General Provider Information

NPI Number	:	1184096356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATY GENTLE SMILES, PLLC

Provider Business Mailing Address
First Line	:	5011 HIGHWAY 6 STE 101
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-4899
Country	:	US
Telephone Number	:	281-206-4444
Fax Number	:	281-205-4301

Provider Business Practice Location Address
First Line	:	5011 HIGHWAY 6 STE 101
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-4899
Country	:	US
Telephone Number	:	281-206-4444
Fax Number	:	281-205-4301

Authorized Official
Title or Position	:	OWNER
Name	:	MANOJ MATHEW
Credential	:
Telephone Number	:	281-878-9800

Provider Enumeration Date	:	10/27/2015
Last Update Date	:	10/27/2015

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