Provider Demographics
NPI:1154675973
Name:SMILE FACTORY PEDIATRIC DENTISTRY P.L.L.C
Entity Type:Organization
Organization Name:SMILE FACTORY PEDIATRIC DENTISTRY P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:ESQUIVEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:830-757-9700
Mailing Address - Street 1:2483 2ND ST STE D
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-4391
Mailing Address - Country:US
Mailing Address - Phone:830-757-9700
Mailing Address - Fax:
Practice Address - Street 1:2483 2ND ST STE D
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4391
Practice Address - Country:US
Practice Address - Phone:830-757-9700
Practice Address - Fax:830-757-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-31
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26518261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental