MEDICARE: SMILE DENTAL CARE PA

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	19801	TX

General Provider Information

NPI Number	:	1760646723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE DENTAL CARE PA

Provider Business Mailing Address
First Line	:	13260 JOSEY LN
Second Line	:	STE# 101
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75234-4973
Country	:	US
Telephone Number	:	972-241-1962
Fax Number	:	972-241-2339

Provider Business Practice Location Address
First Line	:	13260 JOSEY LN
Second Line	:	STE# 101
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75234-4973
Country	:	US
Telephone Number	:	972-241-1962
Fax Number	:	972-241-2339

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KHANH A PHAM
Credential	:	DDS
Telephone Number	:	972-241-1962

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	07/17/2008

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