MEDICARE: SMILEY DENTAL-BEAR CREEK 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	:	1427286632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILEY DENTAL-BEAR CREEK PLLC

Provider Business Mailing Address
First Line	:	PO BOX 453247
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75045-3247
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4376 HIGHWAY 6 N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-3447
Country	:	US
Telephone Number	:	281-856-0600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LYNH T PHAM
Credential	:	DDS
Telephone Number	:	214-718-7880

Provider Enumeration Date	:	06/25/2009
Last Update Date	:	06/29/2009

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