MEDICARE: 1ST SMILE DENTAL, P.A.

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	21049	TX

General Provider Information

NPI Number	:	1548487895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1ST SMILE DENTAL, P.A.

Provider Business Mailing Address
First Line	:	1515 COCKRELL HILL RD
Second Line	:	A111
City	:	DALLAS
State	:	TX
Zip	:	75211-1315
Country	:	US
Telephone Number	:	214-467-7727
Fax Number	:	214-467-7743

Provider Business Practice Location Address
First Line	:	1515 COCKRELL HILL RD
Second Line	:	A111
City	:	DALLAS
State	:	TX
Zip	:	75211-1315
Country	:	US
Telephone Number	:	214-467-7727
Fax Number	:	214-467-7743

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DANA LY
Credential	:	D.D.S.
Telephone Number	:	214-467-7727

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	08/22/2020

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