Provider Demographics
NPI:1215479043
Name:SUPERSMILES DENTAL CENTER
Entity type:Organization
Organization Name:SUPERSMILES DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEYUR
Authorized Official - Middle Name:K
Authorized Official - Last Name:BHAGAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-577-0516
Mailing Address - Street 1:15300 S IH 35
Mailing Address - Street 2:#300
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-9703
Mailing Address - Country:US
Mailing Address - Phone:512-523-8183
Mailing Address - Fax:
Practice Address - Street 1:15300 S IH 35
Practice Address - Street 2:#300
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-9703
Practice Address - Country:US
Practice Address - Phone:512-523-8183
Practice Address - Fax:512-523-8629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty