MEDICARE: TOP SMILE LAKEWOOD 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	122300000X	Dentist

General Provider Information

NPI Number	:	1619631686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOP SMILE LAKEWOOD PLLC

Provider Business Mailing Address
First Line	:	7251 BROOKCOVE LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-1947
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2014 SKILLMAN ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-7240
Country	:	US
Telephone Number	:	972-226-3000
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	NIMA ROHANI
Credential	:	DDS
Telephone Number	:	214-998-9403

Provider Enumeration Date	:	10/26/2021
Last Update Date	:	10/26/2021

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Directions to “TOP SMILE LAKEWOOD PLLC ” Practice Location

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