Healthcare Provider Details

I. General information

NPI: 1265156715
Provider Name (Legal Business Name): SMILEY DENTAL KEMP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 KEMP BLVD
WICHITA FALLS TX
76308-2118
US

IV. Provider business mailing address

PO BOX 450758
GARLAND TX
75045-0758
US

V. Phone/Fax

Practice location:
  • Phone: 940-488-4511
  • Fax: 940-488-4521
Mailing address:
  • Phone: 469-902-6792
  • 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: LYNHTHY T PHAM
Title or Position: OWNER
Credential: DDS
Phone: 469-902-6792