Provider Demographics
NPI:1033641675
Name:SMILE STRONG DENTAL, PLLC
Entity type:Organization
Organization Name:SMILE STRONG DENTAL, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MENBER
Authorized Official - Prefix:
Authorized Official - First Name:SOUMYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-319-6804
Mailing Address - Street 1:9532 VALLEY RANCH PKWY E
Mailing Address - Street 2:#1098
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4903
Mailing Address - Country:US
Mailing Address - Phone:808-319-6805
Mailing Address - Fax:
Practice Address - Street 1:1921 W 15TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7337
Practice Address - Country:US
Practice Address - Phone:972-827-8779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-02
Last Update Date:2017-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29844122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty