Healthcare Provider Details

I. General information

NPI: 1629538814
Provider Name (Legal Business Name): 380 SMILES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 W. UNIVERSITY DR. SUITE 40
PROSPER TX
75078
US

IV. Provider business mailing address

5355 RANDWICK TRL
FRISCO TX
75036-3996
US

V. Phone/Fax

Practice location:
  • Phone: 402-650-7405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIMAL PATEL
Title or Position: MANAGING MEMBER
Credential: DDS
Phone: 402-650-7405