=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700429339
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMILE EXPRESS FAMILY DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2019
-----------------------------------------------------
Last Update Date | 11/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 443 S BROADWAY ST UNIT A
-----------------------------------------------------
City | JOSHUA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76058-3199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-427-9976
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 443 S BROADWAY ST UNIT A1
-----------------------------------------------------
City | JOSHUA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76058-3283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-317-9342
-----------------------------------------------------
Fax | 682-317-9448
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DR
-----------------------------------------------------
Name | UWADIAE UYIGUE
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 720-427-9976
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------