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General NPI Number Information
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NPI Number | 1285090027
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Entity Type | Organization
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Legal Business Name | SMILE PROFILE DENTAL OF TEXAS PLLC
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Dates
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Enumeration Date | 01/09/2016
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Last Update Date | 01/09/2016
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Provider Practice Location Address
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Address Line | 1997 KATY MILLS BLVD STE 500
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City | KATY
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State | TX
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Zip | 77494-4958
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Country | US
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Telephone | 832-953-5052
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Fax |
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Provider Business Mailing Address
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Address Line | 1997 KATY MILLS BLVD STE 500
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City | KATY
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State | TX
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Zip | 77494-4958
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Country | US
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Telephone | 832-953-5052
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GAGANDEEP SINGH KAHLON
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Credential | DDS
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Telephone | 713-417-3121
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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 | 29694
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License Number State | TX
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