Provider Demographics
NPI:1417445388
Name:SERENE SMILES DENTISTRY PLLC
Entity Type:Organization
Organization Name:SERENE SMILES DENTISTRY PLLC
Other - Org Name:SERENE SMILES DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHILPA
Authorized Official - Middle Name:S
Authorized Official - Last Name:AGADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-702-2250
Mailing Address - Street 1:951 W ROUND GROVE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-7902
Mailing Address - Country:US
Mailing Address - Phone:469-702-2250
Mailing Address - Fax:
Practice Address - Street 1:951 W ROUND GROVE RD STE 300
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-7902
Practice Address - Country:US
Practice Address - Phone:732-939-9236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-26
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX308721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225276256OtherPPO & MEDICAID