Provider Demographics
NPI:1154630309
Name:GUNJAN DHIR PA
Entity Type:Organization
Organization Name:GUNJAN DHIR PA
Other - Org Name:FAMILY SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GUNJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DHIR
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, MS
Authorized Official - Phone:617-281-7947
Mailing Address - Street 1:708 PALUXY RD
Mailing Address - Street 2:STE B
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048
Mailing Address - Country:US
Mailing Address - Phone:617-281-7947
Mailing Address - Fax:
Practice Address - Street 1:708 PALUXY RD
Practice Address - Street 2:STE B
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2396
Practice Address - Country:US
Practice Address - Phone:617-281-7947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0243481223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty