Provider Demographics
NPI:1558093146
Name:EVEREST SMILE CARE, LLC
Entity Type:Organization
Organization Name:EVEREST SMILE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-316-1920
Mailing Address - Street 1:11626 T C JESTER BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-1323
Mailing Address - Country:US
Mailing Address - Phone:346-316-1920
Mailing Address - Fax:
Practice Address - Street 1:11626 T C JESTER BLVD STE 400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067-1323
Practice Address - Country:US
Practice Address - Phone:346-316-1920
Practice Address - Fax:832-286-1406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85-1639972Medicaid