Provider Demographics
NPI:1245595701
Name:SHK SMILE DENTAL CORPORTATION
Entity Type:Organization
Organization Name:SHK SMILE DENTAL CORPORTATION
Other - Org Name:1ST SMILE DENTAL CARE OF IRVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-736-3777
Mailing Address - Street 1:3626 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 235
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3643
Mailing Address - Country:US
Mailing Address - Phone:214-736-3777
Mailing Address - Fax:214-736-3778
Practice Address - Street 1:3626 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 235
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3643
Practice Address - Country:US
Practice Address - Phone:214-736-3777
Practice Address - Fax:214-736-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX276771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty