Provider Demographics
NPI:1356199525
Name:SMILESH
Entity type:Organization
Organization Name:SMILESH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SUBEA
Authorized Official - Middle Name:
Authorized Official - Last Name:HIJAZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-455-6503
Mailing Address - Street 1:18633 AMBERG PL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-1020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2690 E HIGHWAY 290
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-3971
Practice Address - Country:US
Practice Address - Phone:512-607-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental