Provider Demographics
NPI:1104567395
Name:ENNIS SMILES PLLC
Entity type:Organization
Organization Name:ENNIS SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKHWANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-423-4032
Mailing Address - Street 1:1012 E ENNIS AVE
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-4345
Mailing Address - Country:US
Mailing Address - Phone:972-875-2501
Mailing Address - Fax:
Practice Address - Street 1:1012 E ENNIS AVE
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-4345
Practice Address - Country:US
Practice Address - Phone:972-875-2501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty