Healthcare Provider Details

I. General information

NPI: 1346905817
Provider Name (Legal Business Name): SMILE BLVD., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 W CAMPBELL RD STE 101
RICHARDSON TX
75080-3396
US

IV. Provider business mailing address

660 W CAMPBELL RD STE 101
RICHARDSON TX
75080-3396
US

V. Phone/Fax

Practice location:
  • Phone: 954-608-9984
  • Fax:
Mailing address:
  • Phone: 972-736-9843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARIA NGUYEN
Title or Position: OWNER
Credential: DMD1
Phone: 954-608-9984