Healthcare Provider Details

I. General information

NPI: 1093272932
Provider Name (Legal Business Name): DENTAL SMILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BARBARA JORDAN BLVD STE 1435
AUSTIN TX
78723-3099
US

IV. Provider business mailing address

1201 BARBARA JORDAN BLVD STE 1435
AUSTIN TX
78723-3099
US

V. Phone/Fax

Practice location:
  • Phone: 512-467-9955
  • Fax: 512-322-9966
Mailing address:
  • Phone: 512-467-9955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DIVYA Y SHETTY
Title or Position: OWNER
Credential: DMD
Phone: 512-467-9955