Healthcare Provider Details

I. General information

NPI: 1891035499
Provider Name (Legal Business Name): PORT ARTHUR SMILES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4997 N TWIN CITY HWY
PORT ARTHUR TX
77642-5845
US

IV. Provider business mailing address

4997 N TWIN CITY HWY
PORT ARTHUR TX
77642-5845
US

V. Phone/Fax

Practice location:
  • Phone: 281-328-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. DHAVAL THAKKAR
Title or Position: OWNER /PROVIDER
Credential: DMD
Phone: 409-548-0685