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General NPI Number Information
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NPI Number | 1346905817
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Entity Type | Organization
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Legal Business Name | SMILE BLVD., PLLC
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Dates
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Enumeration Date | 11/01/2021
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | 660 W CAMPBELL RD STE 101
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City | RICHARDSON
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State | TX
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Zip | 75080-3396
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Country | US
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Telephone | 954-608-9984
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Fax |
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Provider Business Mailing Address
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Address Line | 660 W CAMPBELL RD STE 101
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City | RICHARDSON
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State | TX
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Zip | 75080-3396
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Country | US
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Telephone | 972-736-9843
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARIA NGUYEN
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Credential | DMD1
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Telephone | 954-608-9984
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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 |
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License Number State |
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