Provider Demographics
NPI:1316393655
Name:CITY SMILES DENTAL
Entity Type:Organization
Organization Name:CITY SMILES DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:281-589-6100
Mailing Address - Street 1:14740 BARRYKNOLL LN
Mailing Address - Street 2:SUITE 160
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2884
Mailing Address - Country:US
Mailing Address - Phone:281-589-6100
Mailing Address - Fax:281-752-0256
Practice Address - Street 1:14740 BARRYKNOLL LN
Practice Address - Street 2:SUITE 160
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2884
Practice Address - Country:US
Practice Address - Phone:281-589-6100
Practice Address - Fax:281-752-0256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty