Healthcare Provider Details

I. General information

NPI: 1821222407
Provider Name (Legal Business Name): MARKETPLACE SMILES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 DEL WEBB BLVD STE 104
GEORGETOWN TX
78633-4354
US

IV. Provider business mailing address

400 DEL WEBB BLVD STE 104
GEORGETOWN TX
78633-4354
US

V. Phone/Fax

Practice location:
  • Phone: 512-868-5000
  • Fax: 512-868-5001
Mailing address:
  • Phone: 512-868-5000
  • Fax: 512-868-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number23130
License Number StateTX

VIII. Authorized Official

Name: DR. PATRICK STANLEY BELL
Title or Position: OWNER
Credential: D.D.S.
Phone: 512-868-5000