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General NPI Number Information
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NPI Number | 1578894986
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Entity Type | Organization
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Legal Business Name | SMILE PROVIDERS, PC
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Dates
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Enumeration Date | 01/25/2010
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Last Update Date | 01/25/2010
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Provider Practice Location Address
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Address Line | 2802 GARTH RD STE 311
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City | BAYTOWN
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State | TX
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Zip | 77521-3957
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Country | US
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Telephone | 281-427-7376
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Fax | 281-422-9322
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Provider Business Mailing Address
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Address Line | 2802 GARTH RD STE 311
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City | BAYTOWN
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State | TX
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Zip | 77521-3957
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Country | US
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Telephone | 281-427-7376
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Fax | 281-422-9322
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Authorized Official
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Title or Position | OWNER
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Name | DR. GERARDO GUAJARDO
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Credential | DDS, MSD
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Telephone | 281-427-7376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 23141
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License Number State | TX
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