MEDICARE: SMILE CHAMPS, 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1972782357	OTHER		CMS NATIONAL PLAN AND PROVIDER ENUMERATION SYSTEM
2	1013638592	OTHER		CMS NATIONAL PLAN AND PROVIDER ENUMERATION SYSTEM

General Provider Information

NPI Number	:	1427870518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE CHAMPS, PLLC

Provider Business Mailing Address
First Line	:	3023 THOUSAND OAKS DR STE 108
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-3557
Country	:	US
Telephone Number	:	210-233-9303
Fax Number	:

Provider Business Practice Location Address
First Line	:	3023 THOUSAND OAKS DR STE 108
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-3557
Country	:	US
Telephone Number	:	210-233-9303
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ORTHODONTIST
Name	:	DR. PATRICIA C CHIEN
Credential	:	DDS
Telephone Number	:	210-233-9303

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	10/29/2024

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Directions to “SMILE CHAMPS, PLLC ” Practice Location

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