Provider Demographics
NPI:1245504695
Name:SMILE & SHINE,PLLC
Entity type:Organization
Organization Name:SMILE & SHINE,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARJAP
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:NANVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-263-1222
Mailing Address - Street 1:5326 E US HIGHWAY 83
Mailing Address - Street 2:A3
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-9409
Mailing Address - Country:US
Mailing Address - Phone:956-263-1222
Mailing Address - Fax:956-263-1566
Practice Address - Street 1:5326 E US HIGHWAY 83
Practice Address - Street 2:A3
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-9409
Practice Address - Country:US
Practice Address - Phone:956-263-1222
Practice Address - Fax:956-263-1566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2022196Medicaid