Provider Demographics
NPI:1548590128
Name:GAURAV PURI PA
Entity Type:Organization
Organization Name:GAURAV PURI PA
Other - Org Name:FAMILY SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GAURAV
Authorized Official - Middle Name:
Authorized Official - Last Name:PURI
Authorized Official - Suffix:
Authorized Official - Credentials:BDS,MS
Authorized Official - Phone:617-281-7941
Mailing Address - Street 1:225 EXCHANGE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-4588
Mailing Address - Country:US
Mailing Address - Phone:817-426-9337
Mailing Address - Fax:817-426-9336
Practice Address - Street 1:8113 CAMP BOWIE W
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76116-6314
Practice Address - Country:US
Practice Address - Phone:617-281-7941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty