Provider Demographics
NPI:1396365177
Name:SUGARLAND SMILE CENTER PLLC
Entity Type:Organization
Organization Name:SUGARLAND SMILE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:K
Authorized Official - Last Name:KOTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-202-9153
Mailing Address - Street 1:3811 PEARL LAKE LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4883
Mailing Address - Country:US
Mailing Address - Phone:832-202-9153
Mailing Address - Fax:
Practice Address - Street 1:17101 W GRAND PKWY S
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4984
Practice Address - Country:US
Practice Address - Phone:832-202-9153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental