Provider Demographics
NPI:1578894986
Name:SMILE PROVIDERS, PC
Entity Type:Organization
Organization Name:SMILE PROVIDERS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:281-427-7376
Mailing Address - Street 1:2802 GARTH RD STE 311
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3957
Mailing Address - Country:US
Mailing Address - Phone:281-427-7376
Mailing Address - Fax:281-422-9322
Practice Address - Street 1:2802 GARTH RD STE 311
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3957
Practice Address - Country:US
Practice Address - Phone:281-427-7376
Practice Address - Fax:281-422-9322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty