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Organization
SMILE123PLLC
Active
Organization
SMILE123PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANVI DUSANE (PRESIDENT)
(281) 853-4249
Entity
Organization
Contact information
Practice address
1220 N VELASCO ST, ANGLETON, TX 77515-3197
(979) 849-5771
(979) 849-0555
Mailing address
1220 N VELASCO ST, ANGLETON, TX 77515-3197
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
02/04/2019
Last updated
05/24/2021
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