Provider Demographics
NPI:1992080378
Name:AMERISMILES DENTAL OF MESQUITE PLLC
Entity type:Organization
Organization Name:AMERISMILES DENTAL OF MESQUITE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:NALLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:214-827-1305
Mailing Address - Street 1:3600 GUS THOMASSON RD
Mailing Address - Street 2:SUITE # 145
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3600 GUS THOMASSON RD
Practice Address - Street 2:SUITE # 145
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6200
Practice Address - Country:US
Practice Address - Phone:214-827-1305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX259491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty