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General NPI Number Information
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NPI Number | 1215237771
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Entity Type | Organization
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Legal Business Name | FAMILY SMILES OF ENNIS PC
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Dates
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Enumeration Date | 10/29/2010
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Last Update Date | 10/29/2010
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Provider Practice Location Address
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Address Line | 1012 E ENNIS AVE
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City | ENNIS
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State | TX
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Zip | 75119-4345
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Country | US
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Telephone | 617-281-7947
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Fax |
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Provider Business Mailing Address
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Address Line | 8337 SUMMER PARK DR
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City | FORT WORTH
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State | TX
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Zip | 76123-1991
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Country | US
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Telephone | 817-350-4943
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. GUNJAN DHIR
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Credential | BDS, MS
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Telephone | 617-281-7947
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 24348
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License Number State | TX
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