# SMILE BAR PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033965009
- **Authorized official:** NICHOLE KOSTIUK DMD (DENTIST)
- **Authorized official phone:** (941) 875-7002

## Contact information

- **Practice address:** 9901 BRODIE LN STE 130, AUSTIN, TX 78748-5889
- **Practice address phone:** (737) 204-7208
- **Mailing address:** 7329 CORDOBA DR, AUSTIN, TX 78724-6251
- **Mailing address phone:** (941) 875-7002

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/29/2024
- **Last updated:** 04/29/2024