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General NPI Number Information
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NPI Number | 1104094077
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Entity Type | Organization
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Legal Business Name | GR8 SMILES ORTHODONTICS
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 2440 N JOSEY LN SUITE # 201
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City | CARROLLTON
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State | TX
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Zip | 75006-1668
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Country | US
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Telephone | 972-242-2345
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Fax | 972-446-0450
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Provider Business Mailing Address
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Address Line | 2440 N JOSEY LN SUITE # 201
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City | CARROLLTON
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State | TX
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Zip | 75006-1668
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Country | US
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Telephone | 972-242-2345
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Fax | 972-446-0450
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. ROBERT BORKOWSKI
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Credential | DDS, MD
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Telephone | 972-242-2345
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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 | 18933
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License Number State | TX
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