Provider Demographics
NPI:1043854995
Name:SA SMILES, PLLC
Entity Type:Organization
Organization Name:SA SMILES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GENARO
Authorized Official - Middle Name:
Authorized Official - Last Name:CANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-923-5422
Mailing Address - Street 1:1114 SW MILITARY DR STE 112
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1512
Mailing Address - Country:US
Mailing Address - Phone:210-923-5422
Mailing Address - Fax:
Practice Address - Street 1:1114 SW MILITARY DR STE 112
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1512
Practice Address - Country:US
Practice Address - Phone:210-923-5422
Practice Address - Fax:210-923-2974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty