Provider Demographics
NPI:1447539606
Name:TEXAS STAR SMILES
Entity type:Organization
Organization Name:TEXAS STAR SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZAN
Authorized Official - Middle Name:V
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:254-781-8177
Mailing Address - Street 1:2300 E RANCIER AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-3400
Mailing Address - Country:US
Mailing Address - Phone:254-781-8177
Mailing Address - Fax:
Practice Address - Street 1:2300 E RANCIER AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-3400
Practice Address - Country:US
Practice Address - Phone:254-781-8177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty