Provider Demographics
NPI:1275554404
Name:TEXAS SMILES P.A.
Entity Type:Organization
Organization Name:TEXAS SMILES P.A.
Other - Org Name:TEXAS SMILES DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELOISE
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:ANGULO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-530-1900
Mailing Address - Street 1:10216 BEECHNUT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-5016
Mailing Address - Country:US
Mailing Address - Phone:281-530-1900
Mailing Address - Fax:
Practice Address - Street 1:10216 BEECHNUT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-5016
Practice Address - Country:US
Practice Address - Phone:281-530-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1625709-01Medicaid