Provider Demographics
NPI:1508453648
Name:P&G SMILES LLC
Entity Type:Organization
Organization Name:P&G SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PRASHANTI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLLU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS, MBA
Authorized Official - Phone:617-849-0751
Mailing Address - Street 1:1450 W HORIZON RIDGE PKWY STE B308&309
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4477
Mailing Address - Country:US
Mailing Address - Phone:702-703-0102
Mailing Address - Fax:702-723-6773
Practice Address - Street 1:1450 W HORIZON RIDGE PKWY STE B308&309
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-4477
Practice Address - Country:US
Practice Address - Phone:702-703-0102
Practice Address - Fax:702-723-6773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty