=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265019202
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CUDDLY SMILES PEDIATRIC DENTISTRY & ORTHODONTICS P.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2021
-----------------------------------------------------
Last Update Date | 04/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 E BETHANY DR STE D
-----------------------------------------------------
City | ALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75002-4096
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-342-0080
-----------------------------------------------------
Fax | 469-342-0086
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 E BETHANY DR STE D
-----------------------------------------------------
City | ALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75002-4096
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-342-0080
-----------------------------------------------------
Fax | 469-342-0086
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PEDIATRIC DENTIST/ OWNER
-----------------------------------------------------
Name | DR. YVONNE AKOSUA FELLI
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 956-771-8625
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------