Provider Demographics
NPI:1265861181
Name:IDENTAL SMILE CLINIC PC
Entity Type:Organization
Organization Name:IDENTAL SMILE CLINIC PC
Other - Org Name:ISMILE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-842-2500
Mailing Address - Street 1:4429 GRIGGS RD STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-2852
Mailing Address - Country:US
Mailing Address - Phone:713-842-2500
Mailing Address - Fax:713-842-4224
Practice Address - Street 1:4429 GRIGGS RD STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-2852
Practice Address - Country:US
Practice Address - Phone:713-842-2500
Practice Address - Fax:713-842-4224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX262151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty