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General NPI Number Information
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NPI Number | 1992184113
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Entity Type | Organization
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Legal Business Name | LANCASTERFAMILYSMILES
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 1305 N BLUEGROVE RD
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City | LANCASTER
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State | TX
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Zip | 75134-2939
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Country | US
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Telephone | 703-342-8212
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Fax | 917-591-5476
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Provider Business Mailing Address
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Address Line | 1305 N BLUEGROVE RD
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City | LANCASTER
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State | TX
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Zip | 75134-2939
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Country | US
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Telephone | 703-342-8212
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Fax | 917-591-5476
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Authorized Official
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Title or Position | DENTIST/DIRECTOR
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Name | MAHIMA GUPTA
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Credential | DDS
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Telephone | 703-342-8212
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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 | 29251
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License Number State | TX
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