Provider Demographics
NPI:1881044733
Name:POTRANCO SMILES PLLC
Entity Type:Organization
Organization Name:POTRANCO SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DHAVAL
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:903-360-8657
Mailing Address - Street 1:12903 TAMARACK BEND LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-1569
Mailing Address - Country:US
Mailing Address - Phone:617-771-2784
Mailing Address - Fax:
Practice Address - Street 1:12903 TAMARACK BEND LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-1569
Practice Address - Country:US
Practice Address - Phone:617-771-2784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty