NPIMap

Organization Active NPI

We Create Your Perfect Smile PC

  • General Practice Dentistry
  • Kemah, TX
National Provider Identifier
1700260718
Registry record updated Jul 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
22158 Issued in TX
Legal business name
WE CREATE YOUR PERFECT SMILE PC
Practice address
1939 Lawrence Rd
Kemah, TX 77565-3122
Phone
(281) 538-9300
Fax
(281) 538-9031
NPI assigned
Jul 20, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tracie L Devault, DDSNPI 1396924833
Title
Partner
Phone
(281) 538-9300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 22158 TX Primary

Addresses

Primary practice location

1939 Lawrence Rd
Kemah, TX 77565-3122

Mailing address

1939 Lawrence Rd
Kemah, TX 77565-3122
Phone (281) 538-9300

Other names 1

  • YOUR PERFECT SMILE Doing business as

National Provider Directory

National Provider Directory

Locations

1939 Lawrence Rd
Kemah, TX 77565
Phone (281) 538-9300

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437350400000",
    "number": "1700260718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1939 LAWRENCE RD",
            "city": "KEMAH",
            "state": "TX",
            "postal_code": "775653122",
            "telephone_number": "281-538-9300",
            "fax_number": "281-538-9031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1939 LAWRENCE RD",
            "city": "KEMAH",
            "state": "TX",
            "postal_code": "775653122",
            "telephone_number": "281-538-9300",
            "fax_number": "281-538-9031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WE CREATE YOUR PERFECT SMILE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-20",
        "last_updated": "2015-07-20",
        "status": "A",
        "authorized_official_last_name": "DEVAULT",
        "authorized_official_first_name": "TRACIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "281-538-9300",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "22158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "YOUR PERFECT SMILE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kemah, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.