MEDICARE: SIGNATURE SMILES SURGICAL CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	122300000X	Dentist
2	1223D0001X	Public Health Dentistry
3	1223D0004X	Dental Anesthesiology
4	1223E0200X	Endodontics
5	1223P0106X	Oral and Maxillofacial Pathology Dentistry
6	1223P0221X	Pediatric Dentistry
7	1223P0300X	Periodontics
8	1223P0700X	Prosthodontics
9	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
10	1223X0008X	Oral and Maxillofacial Radiology Dentistry
11	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
12	122400000X	Denturist
13	124Q00000X	Dental Hygienist
14	126800000X	Dental Assistant
15	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1649654724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIGNATURE SMILES SURGICAL CENTER LLC

Provider Business Mailing Address
First Line	:	3800 N SHEPHERD DR # 3B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-6400
Country	:	US
Telephone Number	:	281-224-5331
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 N SHEPHERD DR # 3B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-6400
Country	:	US
Telephone Number	:	281-224-5331
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MISS LOANVY NGUYEN
Credential	:
Telephone Number	:	281-224-5331

Provider Enumeration Date	:	07/17/2015
Last Update Date	:	07/17/2015

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