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General NPI Number Information
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NPI Number | 1447539606
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Entity Type | Organization
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Legal Business Name | TEXAS STAR SMILES
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Dates
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Enumeration Date | 08/05/2011
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Last Update Date | 08/05/2011
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Provider Practice Location Address
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Address Line | 2300 E RANCIER AVE SUITE 110
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City | KILLEEN
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State | TX
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Zip | 76543-3400
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Country | US
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Telephone | 254-781-8177
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 E RANCIER AVE SUITE 110
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City | KILLEEN
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State | TX
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Zip | 76543-3400
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Country | US
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Telephone | 254-781-8177
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUZAN V HARRIS
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Credential | D.D.S
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Telephone | 254-781-8177
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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 | 23157
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License Number State | TX
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