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General NPI Number Information
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NPI Number | 1770765679
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Entity Type | Organization
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Legal Business Name | FOREVER SMILES, P.A.
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 2310 HIGHWAY 157 N SUITE # 102
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City | MANSFIELD
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State | TX
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Zip | 76063-8844
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Country | US
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Telephone | 817-477-2558
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Fax | 817-473-9900
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Provider Business Mailing Address
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Address Line | 2310 HIGHWAY 157 N SUITE # 102
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City | MANSFIELD
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State | TX
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Zip | 76063-8844
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Country | US
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Telephone | 817-477-2558
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Fax | 817-473-9900
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Authorized Official
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Title or Position | CO-OWNER
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Name | YETUNDE O ABAYOMI
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Credential | D.D.S.
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Telephone | 817-477-2558
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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 | 21998
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 21744
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License Number State | TX
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