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General NPI Number Information
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NPI Number | 1396990578
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Entity Type | Organization
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Legal Business Name | SMILEY TOOTH
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 12/01/2008
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Provider Practice Location Address
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Address Line | 2014 S GOLIAD ST SUITE 122
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City | ROCKWALL
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State | TX
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Zip | 75087-4863
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Country | US
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Telephone | 972-772-7553
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Fax | 972-772-7552
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Provider Business Mailing Address
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Address Line | 2014 S GOLIAD ST SUITE 122
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City | ROCKWALL
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State | TX
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Zip | 75087-4863
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Country | US
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Telephone | 972-772-7553
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Fax | 972-772-7552
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JENNIFER ANN CHOU
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Credential | D.D.S.
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Telephone | 972-772-7553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 22035
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License Number State | TX
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