Provider Demographics
NPI:1720526825
Name:PRESTIGIOUS SMILES LLC
Entity Type:Organization
Organization Name:PRESTIGIOUS SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AREZO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARGHOUNI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-880-6666
Mailing Address - Street 1:14119 STUEBNER AIRLINE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-3525
Mailing Address - Country:US
Mailing Address - Phone:281-880-6666
Mailing Address - Fax:832-446-3472
Practice Address - Street 1:14119 STUEBNER AIRLINE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-3525
Practice Address - Country:US
Practice Address - Phone:281-880-6666
Practice Address - Fax:832-446-3472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209631223G0001X
TX326241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197094909OtherTIP