Provider Demographics
NPI:1043895980
Name:SPECIAL SMILES DENTAL AND ORTHODONTICS
Entity Type:Organization
Organization Name:SPECIAL SMILES DENTAL AND ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:AL AZZAWI
Authorized Official - Suffix:
Authorized Official - Credentials:BDS,MS,MS, PHD
Authorized Official - Phone:916-595-3187
Mailing Address - Street 1:13210 LAGUNA SHORES DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-6748
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1875 COUNTY ROAD 101 STE 150
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-2136
Practice Address - Country:US
Practice Address - Phone:821-607-5155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental