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General NPI Number Information
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NPI Number | 1023666328
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Entity Type | Organization
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Legal Business Name | TEXAS SUPER SMILES FOR KIDS LLC
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Dates
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Enumeration Date | 08/29/2019
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Last Update Date | 08/29/2019
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Provider Practice Location Address
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Address Line | 2615 W 24TH ST
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City | PLAINVIEW
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State | TX
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Zip | 79072-1809
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Country | US
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Telephone | 806-296-6057
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Fax | 806-293-5151
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Provider Business Mailing Address
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Address Line | 2615 W 24TH ST
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City | PLAINVIEW
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State | TX
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Zip | 79072-1809
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Country | US
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Telephone | 806-296-6057
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Fax | 806-293-5151
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN MONTOYA
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Credential | DDS
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Telephone | 480-516-1171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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