MEDICARE: SMILEY DENTAL WEBB CHAPEL 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	:	1417275124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILEY DENTAL WEBB CHAPEL PLLC

Provider Business Mailing Address
First Line	:	PO BOX 450758
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75045-0758
Country	:	US
Telephone Number	:	214-718-7880
Fax Number	:

Provider Business Practice Location Address
First Line	:	3464 WEBB CHAPEL EXT
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-6751
Country	:	US
Telephone Number	:	214-718-7880
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LYNH THY PHAM
Credential	:	DDS
Telephone Number	:	214-718-7880

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	05/06/2010

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