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General NPI Number Information
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NPI Number | 1639674179
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Entity Type | Organization
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Legal Business Name | GROWING SMILES CONWAY
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 4209 N CONWAY AVE STE F
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City | PALMHURST
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State | TX
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Zip | 78573-1482
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Country | US
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Telephone | 956-664-2244
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Fax |
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Provider Business Mailing Address
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Address Line | 6800 N 10TH ST
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City | MCALLEN
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State | TX
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Zip | 78504-3293
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Country | US
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Telephone | 956-664-2244
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Fax | 956-664-9355
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Authorized Official
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Title or Position | OWNER
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Name | DR. CARLOS NASSER MOHAMED
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Credential | DDS
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Telephone | 956-664-2244
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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 | 22226
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License Number State | TX
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