Provider Demographics
NPI:1043575129
Name:AFFINITY SMILES DENTAL, PLLC
Entity Type:Organization
Organization Name:AFFINITY SMILES DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHUONG
Authorized Official - Middle Name:
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-966-0648
Mailing Address - Street 1:6407 COLLEYVILLE BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-6228
Mailing Address - Country:US
Mailing Address - Phone:817-421-1104
Mailing Address - Fax:817-421-2006
Practice Address - Street 1:6407 COLLEYVILLE BLVD
Practice Address - Street 2:STE A
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6228
Practice Address - Country:US
Practice Address - Phone:817-421-1104
Practice Address - Fax:817-421-2006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFINITY SMILES DENTAL, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX238371223G0001X
TX238411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty