MEDICARE: BUCKNER SMILEY DENTAL 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	:	1518016294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKNER SMILEY DENTAL PLLC

Provider Business Mailing Address
First Line	:	PO BOX 451807
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75045-1807
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 S BUCKNER BLVD
Second Line	:	STE 800
City	:	DALLAS
State	:	TX
Zip	:	75227-2373
Country	:	US
Telephone Number	:	972-616-0060
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LYNH T PHAM
Credential	:	DDS
Telephone Number	:	469-767-0796

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	08/22/2020

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