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General NPI Number Information
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NPI Number | 1447797188
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Entity Type | Organization
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Legal Business Name | A SMILE FOR LIFE PLLC
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Dates
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Enumeration Date | 01/19/2017
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 324 MEDALLION CTR
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City | DALLAS
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State | TX
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Zip | 75214-1580
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Country | US
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Telephone | 325-374-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 9616 WEBB CHAPEL RD
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City | DALLAS
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State | TX
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Zip | 75220-4940
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Country | US
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Telephone | 325-374-7777
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SCOTT BRADLEY BROWN
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Credential | D.D.S. M.S.D.
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Telephone | 325-374-7777
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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 | 13529
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License Number State | TX
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