MEDICARE: SMILES FOR A LIFETIME, PA

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1245745686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILES FOR A LIFETIME, PA

Provider Business Mailing Address
First Line	:	117 E HOUSTON ST
Second Line	:
City	:	CLEVELAND
State	:	TX
Zip	:	77327-4509
Country	:	US
Telephone Number	:	281-592-0597
Fax Number	:	281-592-4351

Provider Business Practice Location Address
First Line	:	117 E HOUSTON ST
Second Line	:
City	:	CLEVELAND
State	:	TX
Zip	:	77327-4509
Country	:	US
Telephone Number	:	281-592-0597
Fax Number	:	281-592-4351

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LANETTE SIKES
Credential	:	DDS
Telephone Number	:	281-592-0597

Provider Enumeration Date	:	12/07/2017
Last Update Date	:	12/21/2017

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