Provider Demographics
NPI:1407267487
Name:PORT LAVACA SMILES PLLC
Entity Type:Organization
Organization Name:PORT LAVACA SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEETIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:RASTOGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-369-6941
Mailing Address - Street 1:3838 N SAM HOUSTON PKWY E STE 430
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77032-3418
Mailing Address - Country:US
Mailing Address - Phone:832-369-6941
Mailing Address - Fax:
Practice Address - Street 1:233 CALHOUN PLZ
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-2422
Practice Address - Country:US
Practice Address - Phone:409-548-0685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25968122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty