Provider Demographics
NPI:1366821795
Name:PROSPER SMILES PLLC
Entity Type:Organization
Organization Name:PROSPER SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-650-7405
Mailing Address - Street 1:821 N COLEMAN ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-2303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:821 N COLEMAN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2303
Practice Address - Country:US
Practice Address - Phone:972-347-9617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX276801223G0001X
TX190561223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty