Space City Smiles

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

SPACE CITY SMILES

Practice address

2415 Blalock Rd.
Suite a
Houston, TX 77080

Phone

(832) 380-5149

NPI assigned

Apr 24, 2018

Organization subpart

No

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

Authorized official

Name

Johnathan Phan, DMDNPI 1942722491

Title

Manager

Phone

(713) 363-1338

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Johnathan Phan, DMD

  • Dentist
  • Houston, TX
  • NPI 1942722491
  NPD Authorized official

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

{
    "created_epoch": "1524528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524528000000",
    "number": "1750879912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2415 BLALOCK RD.",
            "address_2": "SUITE A",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77080",
            "telephone_number": "832-380-5149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2415 BLALOCK RD.",
            "address_2": "SUITE A",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77080",
            "telephone_number": "832-380-5149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE CITY SMILES",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-24",
        "last_updated": "2018-04-24",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "JOHNATHAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "713-363-1338",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Space City EMS LLC
• Space City Medicab
• Space City Medical
• Space City Radiology PLLC
• Space City Senior Care, LLC
• Space Therapy Gym LLC
• Spade Chiropractic LLC
• Spade Chiropractic Physical Medicine and Diagnostic Clinic
• Spade Chriporactic Physical Medicine & Diagnostic Clinic
• Melissa Spadone

• Dental Clinic/Center in Houston, TX
• Providers in Houston, TX by specialty
• Dental Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2018; 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.