Healthcare Provider Details

I. General information

NPI: 1790934198
Provider Name (Legal Business Name): SMITA REWARI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 S CAPITAL OF TEXAS HWY A-2
AUSTIN TX
78746-8101
US

IV. Provider business mailing address

1218 SW MILITARY DR
SAN ANTONIO TX
78221-1535
US

V. Phone/Fax

Practice location:
  • Phone: 512-328-4867
  • Fax:
Mailing address:
  • Phone: 210-928-2814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number23904
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: