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General NPI Number Information
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NPI Number | 1851769376
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Entity Type | Organization
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Legal Business Name | CRYSTAL SMILES PLLC
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 1320 CORSICANA HWY. 160
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City | HILSBORO
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State | TX
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Zip | 76645
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Country | US
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Telephone | 732-423-4336
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Fax |
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Provider Business Mailing Address
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Address Line | 1320 CORSICANA HWY. 160
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City | HILSBORO
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State | TX
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Zip | 76645
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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 | OWNER DENTIST
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Name | PAVAN CHILUVOJU
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Credential |
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Telephone | 732-423-4336
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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 | 28728
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License Number State | TX
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