=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427521301
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMILEY DENTAL LEWISVILLE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2019
-----------------------------------------------------
Last Update Date | 04/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 930 W MAIN ST
-----------------------------------------------------
City | LEWISVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75067-3516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-466-1400
-----------------------------------------------------
Fax | 214-367-5896
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10901 GARLAND RD
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75218-2613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-466-1400
-----------------------------------------------------
Fax | 214-367-5896
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JEFFERY MARCUS SEIBERT
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 214-466-1400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------