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General NPI Number Information
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NPI Number | 1538289970
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Entity Type | Organization
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Legal Business Name | SMILES OF ROUND ROCK PA
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1201 S I H 35 SUITE 318
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City | ROUND ROCK
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State | TX
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Zip | 78664-6615
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Country | US
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Telephone | 512-255-4600
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Fax | 512-255-9913
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Provider Business Mailing Address
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Address Line | 1201 S I H 35 SUITE 318
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City | ROUND ROCK
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State | TX
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Zip | 78664-6615
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Country | US
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Telephone | 512-255-4600
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Fax | 512-255-9913
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Authorized Official
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Title or Position | OWNER
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Name | LADAN VATANI
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Credential | DDS
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Telephone | 512-255-4600
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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 |
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License Number State | TX
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