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General NPI Number Information
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NPI Number | 1053167486
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Entity Type | Organization
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Legal Business Name | SMILEWELL
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Dates
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Enumeration Date | 04/26/2024
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Last Update Date | 04/26/2024
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Provider Practice Location Address
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Address Line | 555 E BASSE RD
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City | SAN ANTONIO
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State | TX
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Zip | 78209-8353
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Country | US
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Telephone | 210-988-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 4020 LUZ DEL FARO
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City | SAN ANTONIO
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State | TX
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Zip | 78261-2021
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Country | US
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Telephone | 210-273-3604
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. AMY B JACKSON
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Credential | DDS, MS
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Telephone | 210-273-3604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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