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NPI Code Detail

MEDICARE: SMILE ISLAND DENTAL, PLLC

MEDICARE: SMILE ISLAND DENTAL, 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
11223P0221XPediatric Dentistry16742TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700045861
Entity Type Code : Organization
Provider Name (Legal Business Name) : SMILE ISLAND DENTAL, PLLC
Provider Business Mailing Address
First Line : 6513 PRESTON RD
Second Line : SUITE 500
City : PLANO
State : TX
Zip : 75024-2688
Country : US
Telephone Number : 972-378-6762
Fax Number : 972-378-6771
Provider Business Practice Location Address
First Line : 6513 PRESTON RD
Second Line : SUITE 500
City : PLANO
State : TX
Zip : 75024-2688
Country : US
Telephone Number : 972-378-6762
Fax Number : 972-378-6771
Authorized Official
Title or Position : OFFICE MANAGER
Name : JENNIFER WEEMS
Credential :
Telephone Number : 972-378-6762
Provider Enumeration Date : 06/04/2008
Last Update Date : 02/09/2012

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