MEDICARE: SMILEY DENTAL BALCH SPRINGS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	19887	TX

General Provider Information

NPI Number	:	1124345772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILEY DENTAL BALCH SPRINGS PLLC

Provider Business Mailing Address
First Line	:	PO BOX 942045
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75094-2045
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12350 LAKE JUNE RD STE 102
Second Line	:
City	:	BALCH SPRINGS
State	:	TX
Zip	:	75180-1600
Country	:	US
Telephone Number	:	972-913-0110
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LYNH T PHAM
Credential	:
Telephone Number	:	214-718-7880

Provider Enumeration Date	:	04/22/2010
Last Update Date	:	04/22/2010

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