Provider Demographics
NPI:1821573411
Name:AC SMILES DENTAL MANAGEMENT LLC
Entity Type:Organization
Organization Name:AC SMILES DENTAL MANAGEMENT LLC
Other - Org Name:AC SMILES DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-550-5757
Mailing Address - Street 1:11360 BELLAIRE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-2532
Mailing Address - Country:US
Mailing Address - Phone:832-617-8518
Mailing Address - Fax:
Practice Address - Street 1:11360 BELLAIRE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-2532
Practice Address - Country:US
Practice Address - Phone:832-617-8518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280407204Medicaid