Provider Demographics
NPI:1194604066
Name:ELITE SMILE CENTER OF THE WOODLANDS, PLLC
Entity type:Organization
Organization Name:ELITE SMILE CENTER OF THE WOODLANDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-404-2808
Mailing Address - Street 1:121 VISION PARK BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3028
Mailing Address - Country:US
Mailing Address - Phone:832-404-2808
Mailing Address - Fax:832-409-0201
Practice Address - Street 1:121 VISION PARK BLVD STE 130
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3028
Practice Address - Country:US
Practice Address - Phone:832-404-2808
Practice Address - Fax:832-409-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty