Provider Demographics
NPI:1023431442
Name:BELLA SMILES PLLC
Entity type:Organization
Organization Name:BELLA SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:617-281-7941
Mailing Address - Street 1:1401 S JEFFERSON AVE
Mailing Address - Street 2:#4
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-5643
Mailing Address - Country:US
Mailing Address - Phone:617-281-7941
Mailing Address - Fax:
Practice Address - Street 1:1401 S JEFFERSON AVE
Practice Address - Street 2:#4
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-5643
Practice Address - Country:US
Practice Address - Phone:617-281-7941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24365122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX24365OtherLICENSE