Provider Demographics
NPI:1932585890
Name:GREAT AMERICAN SMILES, PC
Entity Type:Organization
Organization Name:GREAT AMERICAN SMILES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF SMILE MAKER
Authorized Official - Prefix:DR
Authorized Official - First Name:M
Authorized Official - Middle Name:CAROLINE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-820-6146
Mailing Address - Street 1:11615 ANGUS RD STE 116
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4065
Mailing Address - Country:US
Mailing Address - Phone:512-345-9995
Mailing Address - Fax:512-340-9229
Practice Address - Street 1:11615 ANGUS RD STE 116
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4065
Practice Address - Country:US
Practice Address - Phone:512-345-9995
Practice Address - Fax:512-340-9229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX263421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty