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General NPI Number Information
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NPI Number | 1932490893
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Entity Type | Organization
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Legal Business Name | SMILE STOP P.C.
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 820 S FRIENDSWOOD DR STE 102
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City | FRIENDSWOOD
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State | TX
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Zip | 77546-4543
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Country | US
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Telephone | 281-482-2640
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Fax | 281-482-0545
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Provider Business Mailing Address
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Address Line | 820 S FRIENDSWOOD DR STE 102
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City | FRIENDSWOOD
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State | TX
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Zip | 77546-4543
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Country | US
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Telephone | 281-482-2640
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Fax | 281-482-0545
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | GERARDO GUAJARDO GUAJARDO
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Credential | D.D.S., M.S.D.
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Telephone | 281-482-2640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 23141
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License Number State | TX
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