Provider Demographics
NPI:1235402371
Name:SMILE 360 PLLC
Entity Type:Organization
Organization Name:SMILE 360 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:KING
Authorized Official - Last Name:IP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-814-2084
Mailing Address - Street 1:1509 S. LAMAR BLVD #675
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704
Mailing Address - Country:US
Mailing Address - Phone:512-444-4746
Mailing Address - Fax:512-442-4750
Practice Address - Street 1:1509 S LAMAR BLVD
Practice Address - Street 2:SUITE 675
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704
Practice Address - Country:US
Practice Address - Phone:512-444-4746
Practice Address - Fax:512-442-4750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty