Basic Information
| Provider Information | |||||||||
| NPI: | 1154630309 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GUNJAN DHIR PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FAMILY SMILES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 708 PALUXY RD | ||||||||
| Address2: | STE B | ||||||||
| City: | GRANBURY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172817947 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 708 PALUXY RD | ||||||||
| Address2: | STE B | ||||||||
| City: | GRANBURY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760482396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172817947 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2010 | ||||||||
| LastUpdateDate: | 10/05/2010 | ||||||||
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| AuthorizedOfficialLastName: | DHIR | ||||||||
| AuthorizedOfficialFirstName: | GUNJAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6172817947 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | BDS, MS | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0700X | 024348 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | Prosthodontics | 1223G0001X | 024348 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.