Provider Demographics
NPI:1407267073
Name:SMILE CLUB PLLC
Entity Type:Organization
Organization Name:SMILE CLUB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TEJASH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:936-681-8592
Mailing Address - Street 1:400 EAST HWY 90 SUITE 402
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535
Mailing Address - Country:US
Mailing Address - Phone:936-681-8592
Mailing Address - Fax:
Practice Address - Street 1:400 E HIGHWAY 90 STE 402
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-2630
Practice Address - Country:US
Practice Address - Phone:936-681-8592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty