Healthcare Provider Details

I. General information

NPI: 1992034482
Provider Name (Legal Business Name): SMILE STRAIGHT ORTHODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 N ZARAGOZA RD # B
EL PASO TX
79936-7905
US

IV. Provider business mailing address

1502 N ZARAGOZA RD # B
EL PASO TX
79936-7905
US

V. Phone/Fax

Practice location:
  • Phone: 915-855-4442
  • Fax: 915-313-7960
Mailing address:
  • Phone: 915-855-4442
  • Fax: 915-313-7960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number25043
License Number StateTX

VIII. Authorized Official

Name: TERESA ZWICKY
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 480-866-8811