Provider Demographics
NPI:1538289970
Name:SMILES OF ROUND ROCK PA
Entity Type:Organization
Organization Name:SMILES OF ROUND ROCK PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LADAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VATANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-255-4600
Mailing Address - Street 1:1201 S I H 35
Mailing Address - Street 2:SUITE 318
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-6615
Mailing Address - Country:US
Mailing Address - Phone:512-255-4600
Mailing Address - Fax:512-255-9913
Practice Address - Street 1:1201 S I H 35
Practice Address - Street 2:SUITE 318
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-6615
Practice Address - Country:US
Practice Address - Phone:512-255-4600
Practice Address - Fax:512-255-9913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty