Provider Demographics
NPI:1477970598
Name:VERNON SMILES, PC
Entity Type:Organization
Organization Name:VERNON SMILES, PC
Other - Org Name:VERNON SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDEEP
Authorized Official - Middle Name:K
Authorized Official - Last Name:BASRAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-247-3041
Mailing Address - Street 1:1222 DELAWARE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6370
Mailing Address - Country:US
Mailing Address - Phone:831-247-3041
Mailing Address - Fax:
Practice Address - Street 1:4409 HILLCREST DR.
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384
Practice Address - Country:US
Practice Address - Phone:831-247-3041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty