MEDICARE: SMILEY DENTAL LAMAR PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1376214080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILEY DENTAL LAMAR PLLC

Provider Business Mailing Address
First Line	:	PO BOX 450758
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75045-0758
Country	:	US
Telephone Number	:	214-466-1400
Fax Number	:	214-367-5896

Provider Business Practice Location Address
First Line	:	10009 N LAMAR BLVD STE C
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78753-4117
Country	:	US
Telephone Number	:	512-303-3395
Fax Number	:	512-303-0936

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LYNHTHY T PHAM
Credential	:	DDS
Telephone Number	:	214-718-6052

Provider Enumeration Date	:	09/22/2021
Last Update Date	:	12/30/2021

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