Provider Demographics
NPI:1790222685
Name:MADE YA SMILE RAYFORD CROSSING, PLLC
Entity Type:Organization
Organization Name:MADE YA SMILE RAYFORD CROSSING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:KESNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-265-1111
Mailing Address - Street 1:1449 HIGHWAY 6
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-5145
Mailing Address - Country:US
Mailing Address - Phone:281-265-1111
Mailing Address - Fax:281-566-2720
Practice Address - Street 1:2833 RILEY FUZZELL RD
Practice Address - Street 2:SUITE 700
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-2806
Practice Address - Country:US
Practice Address - Phone:281-566-2813
Practice Address - Fax:281-566-2861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14415261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental