Healthcare Provider Details

I. General information

NPI: 1003322678
Provider Name (Legal Business Name): UNITED SMILE CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3248 S PRESTON RD STE 140
CELINA TX
75009-3899
US

IV. Provider business mailing address

3248 S PRESTON RD STE 140
CELINA TX
75009-3899
US

V. Phone/Fax

Practice location:
  • Phone: 214-851-0130
  • Fax: 214-851-0111
Mailing address:
  • Phone: 214-851-0130
  • Fax: 214-851-0111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number23268
License Number StateTX

VIII. Authorized Official

Name: DOROTHY HERNANDEZ
Title or Position: CREDENTIALING AGENT
Credential:
Phone: 928-779-4404