Provider Demographics
NPI:1396196226
Name:TRU SMILES PC
Entity Type:Organization
Organization Name:TRU SMILES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAVEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEETHARAM SHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-338-9735
Mailing Address - Street 1:2184 SAXON WAY
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5825
Mailing Address - Country:US
Mailing Address - Phone:703-338-9735
Mailing Address - Fax:
Practice Address - Street 1:2184 SAXON WAY
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5825
Practice Address - Country:US
Practice Address - Phone:703-338-9735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX262391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty