Provider Demographics
NPI:1891035499
Name:PORT ARTHUR SMILES INC
Entity Type:Organization
Organization Name:PORT ARTHUR SMILES INC
Other - Org Name:PORT ARTHUR SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER /PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DHAVAL
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:409-548-0685
Mailing Address - Street 1:4997 N TWIN CITY HWY
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-5845
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4997 N TWIN CITY HWY
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-5845
Practice Address - Country:US
Practice Address - Phone:281-328-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty