Provider Demographics
NPI:1659717957
Name:HUNTSVILLE SMILES
Entity Type:Organization
Organization Name:HUNTSVILLE SMILES
Other - Org Name:SMILE MAKER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GAURAV
Authorized Official - Middle Name:
Authorized Official - Last Name:PURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-281-7941
Mailing Address - Street 1:8337 SUMMER PARK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-1991
Mailing Address - Country:US
Mailing Address - Phone:617-281-7941
Mailing Address - Fax:
Practice Address - Street 1:3011 HIGHWAY 30 W
Practice Address - Street 2:SUITE 101C
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-3534
Practice Address - Country:US
Practice Address - Phone:617-281-7947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty