Provider Demographics
NPI:1649669078
Name:SIGNATURE SMILES SURGICAL CENTER, LLC
Entity type:Organization
Organization Name:SIGNATURE SMILES SURGICAL CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-224-5331
Mailing Address - Street 1:3800 N SHEPHERD DR
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-6400
Mailing Address - Country:US
Mailing Address - Phone:713-802-0011
Mailing Address - Fax:
Practice Address - Street 1:3800 N SHEPHERD DR STE 3B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-6400
Practice Address - Country:US
Practice Address - Phone:713-802-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical