Provider Demographics
NPI:1225575210
Name:SMILE BOUTIQUE OF HURST
Entity Type:Organization
Organization Name:SMILE BOUTIQUE OF HURST
Other - Org Name:DX DENTAL, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:THANH-XUAN
Authorized Official - Middle Name:BUI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-615-2205
Mailing Address - Street 1:7040 PRECINCT LINE RD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-2351
Mailing Address - Country:US
Mailing Address - Phone:817-369-4340
Mailing Address - Fax:
Practice Address - Street 1:401 EVENTIDE WAY
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-8201
Practice Address - Country:US
Practice Address - Phone:817-369-4340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28307122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty