Provider Demographics
NPI:1275203911
Name:FABSMILES PEDIATRIC DENTISTRY, PLLC
Entity Type:Organization
Organization Name:FABSMILES PEDIATRIC DENTISTRY, PLLC
Other - Org Name:FABSMILES PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FABIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOSA-BANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-819-9236
Mailing Address - Street 1:11707 W AIRPORT BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEADOWS PLACE
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3196
Mailing Address - Country:US
Mailing Address - Phone:832-899-4442
Mailing Address - Fax:346-309-2193
Practice Address - Street 1:11707 W AIRPORT BLVD STE 103
Practice Address - Street 2:
Practice Address - City:MEADOWS PLACE
Practice Address - State:TX
Practice Address - Zip Code:77477-3196
Practice Address - Country:US
Practice Address - Phone:832-899-4442
Practice Address - Fax:346-309-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2022-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty