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General NPI Number Information
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NPI Number | 1386793073
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Entity Type | Organization
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Legal Business Name | SMILEY DENTAL-FOREST LANE PLLC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3234 FOREST LN
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City | DALLAS
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State | TX
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Zip | 75234-7710
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Country | US
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Telephone | 972-484-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 3234 FOREST LN
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City | DALLAS
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State | TX
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Zip | 75234-7710
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LYNH T PHAM
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Credential |
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Telephone | 469-767-0796
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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 | 19887
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License Number State | TX
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