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General NPI Number Information
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NPI Number | 1306292651
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Entity Type | Organization
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Legal Business Name | SMILES FOR ALL DENTAL PLLC
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Dates
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Enumeration Date | 05/05/2016
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Last Update Date | 05/05/2016
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Provider Practice Location Address
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Address Line | 301 W GRUBB DR
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City | MESQUITE
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State | TX
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Zip | 75149
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Country | US
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Telephone | 469-547-1937
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Fax |
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Provider Business Mailing Address
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Address Line | 301 W GRUBB DR
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City | MESQUITE
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State | TX
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Zip | 75149
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Country | US
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Telephone | 469-547-1937
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MARTIN R MARTIN
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Credential |
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Telephone | 469-547-1937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 21841
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License Number State | TX
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