Provider Demographics
NPI:1336512854
Name:SUCCESSFUL SMILES OF TEXAS
Entity Type:Organization
Organization Name:SUCCESSFUL SMILES OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-270-9773
Mailing Address - Street 1:2541 S IH 35 # 200-140
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7360
Mailing Address - Country:US
Mailing Address - Phone:512-270-9773
Mailing Address - Fax:
Practice Address - Street 1:3100 S CONGRESS AVE # 1F
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6427
Practice Address - Country:US
Practice Address - Phone:512-270-9773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSK01-25-5786OtherNPI: 1922026921