Provider Demographics
NPI:1194001388
Name:SE SMILE BY DESIGN
Entity Type:Organization
Organization Name:SE SMILE BY DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDON
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:ENDSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-799-9540
Mailing Address - Street 1:901 ASHLEMAN ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705-2900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 ASHLEMAN ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705-2900
Practice Address - Country:US
Practice Address - Phone:254-799-9540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19559122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty