Provider Demographics
NPI:1902359987
Name:MARSHALL SMILES PLLC
Entity Type:Organization
Organization Name:MARSHALL SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GAURAV
Authorized Official - Middle Name:
Authorized Official - Last Name:PURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-451-4740
Mailing Address - Street 1:900 E END BLVD N
Mailing Address - Street 2:200
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670
Mailing Address - Country:US
Mailing Address - Phone:903-935-2273
Mailing Address - Fax:
Practice Address - Street 1:900 E END BLVD N
Practice Address - Street 2:200
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670
Practice Address - Country:US
Practice Address - Phone:903-935-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24365122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty