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General NPI Number Information
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NPI Number | 1366347478
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Entity Type | Organization
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Legal Business Name | MOUNTAIN SMILES - SAGINAW PLLC
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Dates
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Enumeration Date | 10/09/2026
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Last Update Date | 10/09/2026
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Provider Practice Location Address
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Address Line | 701 W BAILEY BOSWELL RD
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City | SAGINAW
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State | TX
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Zip | 76179-1011
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Country | US
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Telephone | 817-367-6453
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Fax |
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Provider Business Mailing Address
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Address Line | 701 W BAILEY BOSWELL RD
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City | SAGINAW
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State | TX
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Zip | 76179-1011
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Country | US
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Telephone | 817-367-6453
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | ANGEL GIMENEZ
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Credential |
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Telephone | 719-300-5933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | NULL
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