Healthcare Provider Details

I. General information

NPI: 1205321346
Provider Name (Legal Business Name): PDSMILES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4542 SPRING STUEBNER RD
SPRING TX
77389-4633
US

IV. Provider business mailing address

4542 SPRING STUEBNER RD
SPRING TX
77389-4633
US

V. Phone/Fax

Practice location:
  • Phone: 281-376-2706
  • Fax:
Mailing address:
  • Phone: 281-376-2706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateTX

VIII. Authorized Official

Name: DR. DAVID WHITE
Title or Position: MANAGER
Credential:
Phone: 281-376-2706