MEDICARE: PRESTIGIOUS SMILES LLC

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	32624	TX
2	1223G0001X	General Practice Dentistry	20963	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	197094909	OTHER	TX	TIP

General Provider Information

NPI Number	:	1720526825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGIOUS SMILES LLC

Provider Business Mailing Address
First Line	:	14119 STUEBNER AIRLINE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-3525
Country	:	US
Telephone Number	:	281-880-6666
Fax Number	:	832-446-3472

Provider Business Practice Location Address
First Line	:	14119 STUEBNER AIRLINE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-3525
Country	:	US
Telephone Number	:	281-880-6666
Fax Number	:	832-446-3472

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AREZO ZARGHOUNI
Credential	:	DDS
Telephone Number	:	281-880-6666

Provider Enumeration Date	:	02/08/2017
Last Update Date	:	02/08/2017

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Directions to “PRESTIGIOUS SMILES LLC ” Practice Location

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