Provider Demographics
NPI:1114058914
Name:ALL SMILES DENTAL PROFESSIONALS, PC
Entity Type:Organization
Organization Name:ALL SMILES DENTAL PROFESSIONALS, PC
Other - Org Name:ALL SMILES DENTAL CENTER, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CODEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-642-5757
Mailing Address - Street 1:4901 LBJ FREEWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-6158
Mailing Address - Country:US
Mailing Address - Phone:214-342-5757
Mailing Address - Fax:214-340-4868
Practice Address - Street 1:2628 MATLOCK RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2525
Practice Address - Country:US
Practice Address - Phone:817-468-3077
Practice Address - Fax:817-460-2876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX162061223G0001X, 1223X0400X
1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147940412Medicaid
TX1479404-13Medicaid
TX147940401Medicaid
TX147940403Medicaid
TX147940407Medicaid
TX147940405Medicaid
TX147940406Medicaid
TX147940408Medicaid
TX147940409Medicaid
TX147940404Medicaid
TX147940410Medicaid
TX147940411Medicaid