Healthcare Provider Details

I. General information

NPI: 1821453473
Provider Name (Legal Business Name): SMILE CORNER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 LIVE OAK STREET SUITE C
COMMERCE TX
75428
US

IV. Provider business mailing address

2210 LIVE OAK STREET SUITE C
COMMERCE TX
75428
US

V. Phone/Fax

Practice location:
  • Phone: 617-281-7941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number24364
License Number StateTX

VIII. Authorized Official

Name: GAURAV PURI
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 617-281-7941