Provider Demographics
NPI:1053778118
Name:TEXAS PROSMILES PLLC
Entity type:Organization
Organization Name:TEXAS PROSMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARCHANA
Authorized Official - Middle Name:MANOHAR
Authorized Official - Last Name:LANKUPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-688-5939
Mailing Address - Street 1:6904 TABERNACLE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7560
Mailing Address - Country:US
Mailing Address - Phone:732-688-5939
Mailing Address - Fax:
Practice Address - Street 1:9400 CLIFFORD STREET, STE 110
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108
Practice Address - Country:US
Practice Address - Phone:732-688-5939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX258211223G0001X
TX257411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty