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General NPI Number Information
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NPI Number | 1164137303
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Entity Type | Organization
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Legal Business Name | PREMIER SMILES PLLC
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Dates
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Enumeration Date | 01/23/2023
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 1652 PAT BOOKER RD
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City | UNIVERSAL CITY
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State | TX
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Zip | 78148-3433
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Country | US
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Telephone | 210-658-4011
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Fax | 210-658-3471
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Provider Business Mailing Address
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Address Line | 1652 PAT BOOKER RD
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City | UNIVERSAL CITY
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State | TX
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Zip | 78148-3433
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Country | US
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Telephone | 210-658-4011
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Fax | 210-658-3471
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. IKENNA OKAFOR
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Credential | DDS
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Telephone | 512-599-2491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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