Smile Bar Professional Corporation

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

SMILE BAR PROFESSIONAL CORPORATION

Practice address

9901 Brodie LN Ste 130
Austin, TX 78748-5889

Phone

(737) 204-7208

NPI assigned

Apr 29, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nichole Kostiuk, DMDNPI 1407424955

Title

Dentist

Phone

(941) 875-7002

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nichole Kostiuk, DMD

  • General Practice Dentistry
  • Austin, TX
  • NPI 1407424955
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714348800000",
    "number": "1033965009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7329 CORDOBA DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787246251",
            "telephone_number": "941-875-7002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9901 BRODIE LN STE 130",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787485889",
            "telephone_number": "737-204-7208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILE BAR PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-29",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A",
        "authorized_official_last_name": "KOSTIUK",
        "authorized_official_first_name": "NICHOLE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "941-875-7002",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn A Smathers, PT
• Smazy Enterprise IV LLC
• Smazy Enterprise IV LLC
• Jeremy Matthew Smiddy, RN
• Smile 360 PLLC
• Smile Salon, PLLC
• Smiles by Design
• Smiles for Schools
• Smiley Dental Lamar PLLC
• Nicollette Simone Smiley

• Dental Clinic/Center in Austin, TX
• Providers in Austin, TX by specialty
• Dental Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.