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General NPI Number Information
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NPI Number | 1174278311
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Entity Type | Organization
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Legal Business Name | MIRACLE SMILE FAMILY DENTAL AND ORTHODONTICS PLLC
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Dates
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Enumeration Date | 02/16/2022
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 1001 S HIGHWAY 377 107
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City | AUBREY
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State | TX
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Zip | 76227
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Country | US
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Telephone | 469-346-6112
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Fax |
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Provider Business Mailing Address
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Address Line | 8628 FOREST GLEN DR
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City | IRVING
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State | TX
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Zip | 75063-4201
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Country | US
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Telephone | 469-346-6612
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Fax |
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Authorized Official
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Title or Position | DDS
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Name | DR. NISHA MODI
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Credential |
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Telephone | 469-346-6612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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