Provider Demographics
NPI:1144585688
Name:KATY SMILE DESIGN, PLLC
Entity Type:Organization
Organization Name:KATY SMILE DESIGN, PLLC
Other - Org Name:KATY SMILE DESIGN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-396-4366
Mailing Address - Street 1:24207 KINGSLAND BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494
Mailing Address - Country:US
Mailing Address - Phone:281-396-4366
Mailing Address - Fax:281-396-4367
Practice Address - Street 1:24207 KINGSLAND BOULEVARD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494
Practice Address - Country:US
Practice Address - Phone:281-396-4366
Practice Address - Fax:281-396-4367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX240191223G0001X
TX168041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty