| 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 |
Shanna L. Williams Dds, Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1511 Emerald Plaza, College Station, TX 77845 Phone: 979-695-8029 | |
Southern Smiles, Family & Cosmetic Dentistry Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1132 Midtown Drive, College Station, TX 77845 Phone: 979-846-7799 Fax: 979-326-1510 | |
College Station Dentistry And Orthodontics Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 11671 Fm 2154 Rd Ste 400, College Station, TX 77845 Phone: 979-221-2423 Fax: 979-221-2426 | |
College Station Modern Dentistry Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 915 William D. Fitch Parkway, Suite 300, College Station, TX 77845 Phone: 979-690-7201 | |
Brazos Valley Oral & Maxillofacial Surgery Dental Clinic Medicare: Medicare Enrolled Practice Location: 1505 Emerald Plaza, College Station, TX 77845 Phone: 979-764-7101 Fax: 979-764-7115 | |
Affordable Dentures & Implants - Texas, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2305 Longmire Dr Ste 70, College Station, TX 77845 Phone: 979-977-0047 | |
Brazos Valley Dental Group, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 219 Rock Prairie Rd Ste 100, College Station, TX 77845 Phone: 979-695-8000 Fax: 979-314-9702 |