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General NPI Number Information
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NPI Number | 1316759350
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Entity Type | Organization
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Legal Business Name | SACRED SMILES PLLC
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 7251 CANYON FALLS RD # 401
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City | NORTHLAKE
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State | TX
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Zip | 76226-4543
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Country | US
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Telephone | 214-432-7180
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Fax | 214-432-7190
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Provider Business Mailing Address
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Address Line | 7251 CANYON FALLS RD SUITE #401
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City | NORTHLAKE
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State | TX
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Zip | 76226-4543
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Country | US
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Telephone | 214-909-1769
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | JUNIOR TOBIAS
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Credential | DDS
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Telephone | 214-909-1769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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