Provider Demographics
NPI:1043584212
Name:YOURSMILE DENTISTRY, PLLC
Entity Type:Organization
Organization Name:YOURSMILE DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-335-5455
Mailing Address - Street 1:4670 MCDERMOTT RD.
Mailing Address - Street 2:SUITE#200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024
Mailing Address - Country:US
Mailing Address - Phone:972-335-5455
Mailing Address - Fax:972-335-2040
Practice Address - Street 1:4670 MCDERMOTT RD STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-7791
Practice Address - Country:US
Practice Address - Phone:972-335-5455
Practice Address - Fax:972-335-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty