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General NPI Number Information
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NPI Number | 1396196226
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Entity Type | Organization
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Legal Business Name | TRU SMILES PC
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 06/22/2016
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Provider Practice Location Address
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Address Line | 2184 SAXON WAY
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City | ALLEN
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State | TX
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Zip | 75013-5825
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Country | US
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Telephone | 703-338-9735
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Fax |
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Provider Business Mailing Address
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Address Line | 2184 SAXON WAY
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City | ALLEN
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State | TX
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Zip | 75013-5825
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Country | US
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Telephone | 703-338-9735
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PRAVEENA SEETHARAM SHETTY
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Credential | DMD
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Telephone | 703-338-9735
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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 | 26239
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License Number State | TX
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