Healthcare Provider Details

I. General information

NPI: 1841857349
Provider Name (Legal Business Name): SMILES OF VERNON PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4109 HILLCREST PLZ
VERNON TX
76384-3267
US

IV. Provider business mailing address

4109 HILLCREST PLZ
VERNON TX
76384-3267
US

V. Phone/Fax

Practice location:
  • Phone: 940-552-2269
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. VISHAL KULKARNI
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 484-860-5551