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General NPI Number Information
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NPI Number | 1851272538
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Entity Type | Organization
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Legal Business Name | 3560 BEAUMONT SMILE PROFESSIONAL, PLLC
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Dates
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Enumeration Date | 09/10/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 3560 DELAWARE ST STE 102
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City | BEAUMONT
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State | TX
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Zip | 77706-3059
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Country | US
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Telephone | 409-892-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 3560 DELAWARE ST STE 102
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City | BEAUMONT
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State | TX
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Zip | 77706-3059
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Country | US
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Telephone | 409-892-2600
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Fax |
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | PAM DRAPER
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Credential |
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Telephone | 602-391-4086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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