Crystal Smiles PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

28728 Issued in TX

Legal business name

CRYSTAL SMILES PLLC

Practice address

1320 Corsicana Hwy.
160
Hilsboro, TX 76645

Phone

(732) 423-4336

NPI assigned

Sep 15, 2015

Last updated

Sep 15, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Pavan Chiluvoju

Title

Owner Dentist

Phone

(732) 423-4336

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1442275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442275200000",
    "number": "1851769376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 CORSICANA HWY.",
            "address_2": "160",
            "city": "HILSBORO",
            "state": "TX",
            "postal_code": "76645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 CORSICANA HWY.",
            "address_2": "160",
            "city": "HILSBORO",
            "state": "TX",
            "postal_code": "76645",
            "telephone_number": "732-423-4336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL SMILES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-15",
        "last_updated": "2015-09-15",
        "status": "A",
        "authorized_official_last_name": "CHILUVOJU",
        "authorized_official_first_name": "PAVAN",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "732-423-4336"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "28728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2015; 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.