MEDICARE: SMILES GALORE

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	22283	TX

General Provider Information

NPI Number	:	1336410331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILES GALORE

Provider Business Mailing Address
First Line	:	5734 GASSER LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77085-5200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8527 GULF FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77017-5055
Country	:	US
Telephone Number	:	713-944-2993
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. TAMMEKA NICKLEBERRY
Credential	:	D.D.S
Telephone Number	:	832-654-2143

Provider Enumeration Date	:	01/23/2012
Last Update Date	:	01/23/2012

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Directions to “SMILES GALORE ” Practice Location

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