Healthcare Provider Details

I. General information

NPI: 1558540823
Provider Name (Legal Business Name): SMILE TEXAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 LBJ FWY SUITE 1200
DALLAS TX
75240-2601
US

IV. Provider business mailing address

PO BOX 250310
WEST BLOOMFIELD MI
48325-0310
US

V. Phone/Fax

Practice location:
  • Phone: 888-833-8441
  • Fax: 888-330-4331
Mailing address:
  • Phone: 888-833-8441
  • Fax: 888-330-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MARGO WOLL
Title or Position: CO-DENTAL DIRECTOR
Credential: DDS
Phone: 888-833-8441