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General NPI Number Information
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NPI Number | 1629538814
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Entity Type | Organization
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Legal Business Name | 380 SMILES PLLC
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Dates
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Enumeration Date | 03/22/2019
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Last Update Date | 03/22/2019
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Provider Practice Location Address
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Address Line | 4940 W. UNIVERSITY DR. SUITE 40
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City | PROSPER
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State | TX
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Zip | 75078
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Country | US
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Telephone | 402-650-7405
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Fax |
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Provider Business Mailing Address
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Address Line | 5355 RANDWICK TRL
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City | FRISCO
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State | TX
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Zip | 75036-3996
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | VIMAL PATEL
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Credential | DDS
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Telephone | 402-650-7405
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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 |
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License Number State |
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