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General NPI Number Information
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NPI Number | 1336512854
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Entity Type | Organization
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Legal Business Name | SUCCESSFUL SMILES OF TEXAS
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 3100 S CONGRESS AVE # 1F
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City | AUSTIN
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State | TX
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Zip | 78704-6427
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Country | US
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Telephone | 512-270-9773
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Fax |
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Provider Business Mailing Address
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Address Line | 2541 S IH 35 # 200-140
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City | ROUND ROCK
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State | TX
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Zip | 78664-7360
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Country | US
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Telephone | 512-270-9773
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERIC NEUER
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Credential | DDS
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Telephone | 512-270-9773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 31027
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License Number State | TX
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