Provider Demographics
NPI:1144762030
Name:TROPHY SMILE STUDIO
Entity Type:Organization
Organization Name:TROPHY SMILE STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JAROSLAW
Authorized Official - Middle Name:
Authorized Official - Last Name:WROBEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-778-0337
Mailing Address - Street 1:301 TROPHY LAKE DR
Mailing Address - Street 2:# 120
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-5238
Mailing Address - Country:US
Mailing Address - Phone:817-778-0337
Mailing Address - Fax:817-720-0038
Practice Address - Street 1:301 TROPHY LAKE DR
Practice Address - Street 2:# 120
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-5238
Practice Address - Country:US
Practice Address - Phone:817-778-0337
Practice Address - Fax:817-720-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX297451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty