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General NPI Number Information
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NPI Number | 1255671277
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Entity Type | Organization
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Legal Business Name | SMILE CONCEPTS PA
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Dates
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Enumeration Date | 02/28/2013
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 2200 TRENTON RD SUITE 3A
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City | MCALLEN
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State | TX
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Zip | 78504-6354
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Country | US
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Telephone | 800-868-9908
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 TRENTON RD SUITE 3A
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City | MCALLEN
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State | TX
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Zip | 78504-6354
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JOHN PETER TAN
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Credential | DDS
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Telephone | 310-561-7647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 27351
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License Number State | TX
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