=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932495678
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMILEY DENTAL BISSONNET PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2011
-----------------------------------------------------
Last Update Date | 08/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6047 BISSONNET ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77081-6903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-432-7222
-----------------------------------------------------
Fax | 713-432-7221
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 453247
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-466-1400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DR. LYNHTHY PHAM
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 214-466-1400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 19887
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------