MEDICARE: HUNTSVILLE SMILES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1659717957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUNTSVILLE SMILES

Provider Business Mailing Address
First Line	:	8337 SUMMER PARK DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-1991
Country	:	US
Telephone Number	:	617-281-7941
Fax Number	:

Provider Business Practice Location Address
First Line	:	3011 HIGHWAY 30 W
Second Line	:	SUITE 101C
City	:	HUNTSVILLE
State	:	TX
Zip	:	77340-3534
Country	:	US
Telephone Number	:	617-281-7947
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. GAURAV PURI
Credential	:
Telephone Number	:	617-281-7941

Provider Enumeration Date	:	05/14/2013
Last Update Date	:	05/14/2013

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Directions to “HUNTSVILLE SMILES ” Practice Location

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