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General NPI Number Information
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NPI Number | 1639610181
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Entity Type | Organization
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Legal Business Name | KA SMILE PLUS
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Dates
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Enumeration Date | 03/16/2017
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Last Update Date | 03/16/2017
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Provider Practice Location Address
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Address Line | 617 K AVE STE 300
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City | PLANO
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State | TX
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Zip | 75074-8533
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Country | US
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Telephone | 972-372-9170
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Fax | 972-379-8115
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Provider Business Mailing Address
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Address Line | 617 K AVE STE 300
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City | PLANO
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State | TX
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Zip | 75074-8533
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Country | US
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Telephone | 972-372-9170
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Fax | 972-379-8115
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. JESSICA LIEN
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Credential | DDS
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Telephone | 214-893-2735
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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 | 30385
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License Number State | TX
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