Provider Demographics
NPI:1699212951
Name:MAGIC SMILES PLLC
Entity Type:Organization
Organization Name:MAGIC SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GUNJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DHIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-451-4439
Mailing Address - Street 1:1622 W VILLA MARIA RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77807-2311
Mailing Address - Country:US
Mailing Address - Phone:817-451-4439
Mailing Address - Fax:
Practice Address - Street 1:1622 W VILLA MARIA RD
Practice Address - Street 2:SUITE 140
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77807-2311
Practice Address - Country:US
Practice Address - Phone:817-451-4439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty