Provider Demographics
NPI:1053727628
Name:SMILE STUDIO PLLC
Entity type:Organization
Organization Name:SMILE STUDIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILUVOJU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:936-327-7550
Mailing Address - Street 1:1772 WEST CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77845
Mailing Address - Country:US
Mailing Address - Phone:936-327-7550
Mailing Address - Fax:
Practice Address - Street 1:1772 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-9005
Practice Address - Country:US
Practice Address - Phone:936-327-7550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-03
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX287281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty