Provider Demographics
NPI:1932503943
Name:MADE YA SMILE ELDRIDGE LAKES
Entity Type:Organization
Organization Name:MADE YA SMILE ELDRIDGE LAKES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MS
Authorized Official - First Name:ANH
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-566-2721
Mailing Address - Street 1:9388 N. ELDRIDGE PARKWAY
Mailing Address - Street 2:SUITE #500
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041
Mailing Address - Country:US
Mailing Address - Phone:281-265-1111
Mailing Address - Fax:
Practice Address - Street 1:9388 N. ELDRIDGE PARKWAY
Practice Address - Street 2:SUITE #500
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041
Practice Address - Country:US
Practice Address - Phone:281-265-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX141151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty