Provider Demographics
NPI:1598547861
Name:MYSMILE DENTISTRY PLLC
Entity Type:Organization
Organization Name:MYSMILE DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMEBER/DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARANGINI
Authorized Official - Middle Name:
Authorized Official - Last Name:SUGGALA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:763-772-5304
Mailing Address - Street 1:5931 ALPENROSE AVE
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-8009
Mailing Address - Country:US
Mailing Address - Phone:763-772-5304
Mailing Address - Fax:
Practice Address - Street 1:3044 OLD DENTON RD STE 126
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5099
Practice Address - Country:US
Practice Address - Phone:763-772-5304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty