Healthcare Provider Details

I. General information

NPI: 1255133385
Provider Name (Legal Business Name): SMILE DESIGN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1829 MONTEBELLO
JUAREZ MEXICO
32530
MX

IV. Provider business mailing address

6101 GATEWAY WEST, SPC 520, PMB 313
EL PASO TX
79925
US

V. Phone/Fax

Practice location:
  • Phone: 915-792-2969
  • Fax: 915-465-5912
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. IVONNE HERNANDEZ VILLELA
Title or Position: DENTIST
Credential: DDS
Phone: 915-792-2969