MEDICARE: SMS DENTAL MANAGEMENT, INC

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
2	122300000X	Dentist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497099733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMS DENTAL MANAGEMENT, INC

Provider Business Mailing Address
First Line	:	1414 ELDRIDGE PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-1625
Country	:	US
Telephone Number	:	832-243-4302
Fax Number	:	832-486-9528

Provider Business Practice Location Address
First Line	:	1414 ELDRIDGE PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-1625
Country	:	US
Telephone Number	:	832-243-4302
Fax Number	:	832-486-9528

Authorized Official
Title or Position	:	CFO
Name	:	ALI F KHAN
Credential	:
Telephone Number	:	713-502-6893

Provider Enumeration Date	:	11/26/2012
Last Update Date	:	11/26/2012

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Directions to “SMS DENTAL MANAGEMENT, INC ” Practice Location

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