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General NPI Number Information
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NPI Number | 1649562745
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Entity Type | Organization
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Legal Business Name | PROSMILE DENTAL CARE, PLLC
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Dates
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Enumeration Date | 05/06/2011
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Last Update Date | 05/06/2011
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Provider Practice Location Address
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Address Line | 1919 WIRT RD
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City | HOUSTON
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State | TX
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Zip | 77055-2405
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Country | US
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Telephone | 713-721-8889
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Fax |
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Provider Business Mailing Address
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Address Line | 6327 SPRUCE MANOR LN
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City | HOUSTON
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State | TX
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Zip | 77085-3012
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Country | US
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Telephone | 832-434-2027
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. PAUL LONG
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Credential | D.D.S.
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Telephone | 713-721-8889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 23270
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License Number State | TX
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