Provider Demographics
NPI:1043984834
Name:SMILE IN STYLE PLLC
Entity Type:Organization
Organization Name:SMILE IN STYLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST AND PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AZADEH
Authorized Official - Middle Name:
Authorized Official - Last Name:ESLAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS MS
Authorized Official - Phone:810-333-3930
Mailing Address - Street 1:2515 S LAKELINE BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2963
Mailing Address - Country:US
Mailing Address - Phone:512-666-9192
Mailing Address - Fax:
Practice Address - Street 1:2515 S LAKELINE BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2963
Practice Address - Country:US
Practice Address - Phone:512-666-9192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14226408OtherCAQH