Provider Demographics
NPI:1154470003
Name:SMILEY DENTAL WALNUT, PLLC
Entity Type:Organization
Organization Name:SMILEY DENTAL WALNUT, PLLC
Other - Org Name:MEDALLION SMILEY DENTAL, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNH THY
Authorized Official - Middle Name:T
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DENTIST (DDS)
Authorized Official - Phone:214-466-1400
Mailing Address - Street 1:PO BOX 451268
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75045
Mailing Address - Country:US
Mailing Address - Phone:214-466-1400
Mailing Address - Fax:214-466-1404
Practice Address - Street 1:4431 W WALNUT ST
Practice Address - Street 2:#A
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042
Practice Address - Country:US
Practice Address - Phone:972-485-1200
Practice Address - Fax:972-485-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty