Healthcare Provider Details

I. General information

NPI: 1962357665
Provider Name (Legal Business Name): P&G SMILES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 S MARYLAND PKWY STE 1
LAS VEGAS NV
89183-7148
US

IV. Provider business mailing address

9850 S MARYLAND PKWY STE 1
LAS VEGAS NV
89183-7148
US

V. Phone/Fax

Practice location:
  • Phone: 702-703-0102
  • Fax: 702-723-6773
Mailing address:
  • Phone: 702-703-0102
  • Fax: 702-723-6773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: PRASHANTI BOLLU
Title or Position: ORTHODONTIST
Credential: D.M.D., M.S., M.B.A.
Phone: 617-849-0751