1518232966 NPI number — LIFE SMILES UNLIMITED, LP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518232966 NPI number — LIFE SMILES UNLIMITED, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE SMILES UNLIMITED, LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HILL COUNTRY DENTAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518232966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20770 US HIGHWAY 281 N
Provider Second Line Business Mailing Address:
#110
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78258-7519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-494-4455
Provider Business Mailing Address Fax Number:
210-496-1641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20770 US HIGHWAY 281 N
Provider Second Line Business Practice Location Address:
#110
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78258-7519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-494-4455
Provider Business Practice Location Address Fax Number:
210-496-1641
Provider Enumeration Date:
03/19/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER/ DENTIST
Authorized Official Telephone Number:
210-494-4455

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  12018 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 21394 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)