Provider Demographics
NPI:1467958488
Name:KC SMILES DENTAL MANAGEMENT, LLC
Entity Type:Organization
Organization Name:KC SMILES DENTAL MANAGEMENT, LLC
Other - Org Name:KC SMILES DENTAL MANAGEMENT, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-867-0379
Mailing Address - Street 1:7503 BRIGHTON KNOLLS LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1598
Mailing Address - Country:US
Mailing Address - Phone:832-867-0379
Mailing Address - Fax:
Practice Address - Street 1:7700 HIGHWAY 6 N STE 106
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2672
Practice Address - Country:US
Practice Address - Phone:832-867-0379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental