Provider Demographics
NPI:1073355038
Name:COUNTRYSIDE SMILES PLLC
Entity type:Organization
Organization Name:COUNTRYSIDE SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASPREET KAUR
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-835-3023
Mailing Address - Street 1:518 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-5344
Mailing Address - Country:US
Mailing Address - Phone:972-835-3023
Mailing Address - Fax:
Practice Address - Street 1:222 E FM 544 STE 208
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-0397
Practice Address - Country:US
Practice Address - Phone:972-957-7610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental