Provider Demographics
NPI:1134845845
Name:SMILE DESIGNERS OF TEXAS PLLC
Entity type:Organization
Organization Name:SMILE DESIGNERS OF TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENGAMEH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTEVASEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-603-5226
Mailing Address - Street 1:6723 BEAUFORD DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-8121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7215 WYOMING SPRINGS DR STE 1000
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4318
Practice Address - Country:US
Practice Address - Phone:317-603-5226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty