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General NPI Number Information
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NPI Number | 1578876520
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Entity Type | Organization
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Legal Business Name | PURE SMILES ORTHODONTICS PLLC
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Dates
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Enumeration Date | 07/20/2010
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 4301 W WILLIAM CANNON DR BUILDING E, SUITE 300
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City | AUSTIN
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State | TX
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Zip | 78749-1473
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Country | US
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Telephone | 512-522-5446
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Fax |
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Provider Business Mailing Address
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Address Line | 4301 W WILLIAM CANNON DR BUILDING E, SUITE 300
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City | AUSTIN
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State | TX
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Zip | 78749-1473
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Country | US
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Telephone | 512-522-5446
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. SILVANA GONZALEZ MANZUR
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Credential | D.D.S., MS
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Telephone | 512-522-5446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 23810
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License Number State | TX
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