Healthcare Provider Details

I. General information

NPI: 1619519329
Provider Name (Legal Business Name): SMILEY DENTAL - UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 W UNIVERSITY DR
DENTON TX
76201-0615
US

IV. Provider business mailing address

PO BOX 450758
GARLAND TX
75045-0758
US

V. Phone/Fax

Practice location:
  • Phone: 940-514-0700
  • Fax: 940-514-0701
Mailing address:
  • Phone: 214-466-1400
  • Fax: 214-367-5896

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. LYNHTHY T PHAM
Title or Position: OWNER
Credential: DDS
Phone: 214-718-6052