Provider Demographics
NPI:1023313616
Name:LIFETIME SMILES, PLLC
Entity type:Organization
Organization Name:LIFETIME SMILES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:ARZEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-550-4400
Mailing Address - Street 1:2100 W WILLIAM CANNON DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-4881
Mailing Address - Country:US
Mailing Address - Phone:512-550-4400
Mailing Address - Fax:512-284-8959
Practice Address - Street 1:2100 W WILLIAM CANNON DR
Practice Address - Street 2:SUITE C
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-4881
Practice Address - Country:US
Practice Address - Phone:512-550-4400
Practice Address - Fax:512-284-8959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224341223P0221X
TX23982122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty