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General NPI Number Information
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NPI Number | 1972839397
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Entity Type | Organization
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Legal Business Name | SMILE MAGIC OF DENTON, PLLC
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 3600 E. MCKINNEY ST, SUITE 190
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City | DENTON
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State | TX
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Zip | 76209
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Country | US
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Telephone | 940-387-2442
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Fax | 340-387-2444
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Provider Business Mailing Address
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Address Line | PO BOX 674330
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City | DALLAS
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State | TX
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Zip | 75267
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Country | US
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Telephone | 855-697-6453
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Fax | 855-731-5147
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Authorized Official
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Title or Position | CHIEF DENTAL OFFICER
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Name | DR. EVERETT CHAD EVANS
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Credential | DDS
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Telephone | 940-808-1917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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