MEDICARE: LAKEWOOD SMILES

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1255112926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEWOOD SMILES

Provider Business Mailing Address
First Line	:	11550 LOUETTA RD STE 400
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-1369
Country	:	US
Telephone Number	:	281-914-4469
Fax Number	:	281-914-4569

Provider Business Practice Location Address
First Line	:	11550 LOUETTA RD STE 400
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-1369
Country	:	US
Telephone Number	:	281-914-4469
Fax Number	:	281-914-4569

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. BENJAMIN RAFAIL
Credential	:	DDS
Telephone Number	:	713-397-2954

Provider Enumeration Date	:	10/10/2023
Last Update Date	:	10/10/2023

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Directions to “LAKEWOOD SMILES ” Practice Location

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