Provider Demographics
NPI:1184365322
Name:SANDY SMILES PLLC
Entity type:Organization
Organization Name:SANDY SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SATEESH KUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:UMMAREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:601-832-6320
Mailing Address - Street 1:2625 COLE CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5958
Mailing Address - Country:US
Mailing Address - Phone:601-832-6320
Mailing Address - Fax:
Practice Address - Street 1:2131 N COLLINS ST STE 415
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-2811
Practice Address - Country:US
Practice Address - Phone:817-801-1382
Practice Address - Fax:817-591-4981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-03
Last Update Date:2022-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty