| Brazos Valley Smiles, Pc | |
|
1103 Rock Prairie Rd Ste 1001 College Station TX 77845-8344 | |
| (979) 694-5200 | |
| (979) 694-5223 |
| Full Name | Brazos Valley Smiles, Pc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1103 Rock Prairie Rd Ste 1001, College Station, Texas |
| Authorized Official Name and Position | Ketan Arun Sukkawala (PRESIDENT) |
| Authorized Official Contact | 9796945200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brazos Valley Smiles, Pc 1103 Rock Prairie Rd Ste 1001 College Station TX 77845-8344 Ph: (979) 694-5200 | Brazos Valley Smiles, Pc 1103 Rock Prairie Rd Ste 1001 College Station TX 77845-8344 Ph: (979) 694-5200 |
| NPI Number | 1386924694 |
|---|---|
| Provider Enumeration Date | 08/18/2011 |
| Last Update Date | 06/11/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386924694 | NPI | - | NPPES |
| 280969101 | Medicaid | TX | |
| 009547301 | Medicaid | TX | |
| 26291 | Other | TX | DENTAL LICENSE NUMBER |
| 090878203 | Medicaid | TX | |
| 12102 | Other | TX | DENTAL LICENSE NUMBER |
| 19635 | Other | TX | DENTAL LICENSE NUMBER |
| 316310702 | Medicaid | TX | |
| 26496 | Other | TX | DENTAL LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 19635 (Texas) | Primary |
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