# SMILE REVOLUTION PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Grand Central Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649787524
- **Authorized official:** DR. SHIVANI PATEL DMD (OWNER)
- **Authorized official phone:** (936) 666-4459

## Contact information

- **Practice address:** 600 S CONROE MEDICAL DRIVE, STE 104, CONROE, TX 77304
- **Practice address phone:** (936) 666-4459
- **Mailing address:** 1835 WOODLAND FIELD XING APT 316, THE WOODLANDS, TX 77380-3855

## Taxonomy

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

## Other

- **Enumeration date:** 01/02/2018
- **Last updated:** 01/02/2018