MEDICARE: MEMORIAL CITY SMILES

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1841845518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMORIAL CITY SMILES

Provider Business Mailing Address
First Line	:	902 FROSTWOOD DR STE 166
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2449
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 FROSTWOOD DR STE 166
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2449
Country	:	US
Telephone Number	:	713-461-6161
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KARAM RASSAM
Credential	:
Telephone Number	:	281-794-6835

Provider Enumeration Date	:	08/08/2019
Last Update Date	:	08/08/2019

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Directions to “MEMORIAL CITY SMILES ” Practice Location

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