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General NPI Number Information
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NPI Number | 1821453473
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Entity Type | Organization
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Legal Business Name | SMILE CORNER PLLC
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Dates
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Enumeration Date | 12/28/2015
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Last Update Date | 12/28/2015
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Provider Practice Location Address
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Address Line | 2210 LIVE OAK STREET SUITE C
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City | COMMERCE
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State | TX
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Zip | 75428
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Country | US
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Telephone | 617-281-7941
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Fax |
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Provider Business Mailing Address
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Address Line | 2210 LIVE OAK STREET SUITE C
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City | COMMERCE
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State | TX
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Zip | 75428
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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 | DIRECTOR/OWNER
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Name | GAURAV PURI
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Credential |
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Telephone | 617-281-7941
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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 | 24364
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License Number State | TX
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