Provider Demographics
NPI:1932490893
Name:SMILE STOP P.C.
Entity Type:Organization
Organization Name:SMILE STOP P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:GUAJARDO
Authorized Official - Last Name:GUAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:281-482-2640
Mailing Address - Street 1:820 S FRIENDSWOOD DR STE 102
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-4543
Mailing Address - Country:US
Mailing Address - Phone:281-482-2640
Mailing Address - Fax:281-482-0545
Practice Address - Street 1:820 S FRIENDSWOOD DR STE 102
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-4543
Practice Address - Country:US
Practice Address - Phone:281-482-2640
Practice Address - Fax:281-482-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23141302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization