MEDICARE: HEALTHY SMILES OF TEXAS

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	21579	TX

General Provider Information

NPI Number	:	1306215595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY SMILES OF TEXAS

Provider Business Mailing Address
First Line	:	9226 WICKFORD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-3736
Country	:	US
Telephone Number	:	713-360-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	3651 WESLAYAN ST
Second Line	:	SUITE 208
City	:	HOUSTON
State	:	TX
Zip	:	77027-6833
Country	:	US
Telephone Number	:	713-360-7700
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NISHANO THOMAS
Credential	:	DMD
Telephone Number	:	713-360-7700

Provider Enumeration Date	:	09/18/2015
Last Update Date	:	09/15/2016

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Directions to “HEALTHY SMILES OF TEXAS ” Practice Location

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