Provider Demographics
NPI:1275844383
Name:SMILEY DENTAL LUBBOCK PLLC
Entity Type:Organization
Organization Name:SMILEY DENTAL LUBBOCK PLLC
Other - Org Name:SMILEY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNH
Authorized Official - Middle Name:THY
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-718-7880
Mailing Address - Street 1:PO BOX 450758
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75045-0758
Mailing Address - Country:US
Mailing Address - Phone:214-466-1400
Mailing Address - Fax:469-759-1044
Practice Address - Street 1:3112 LUBBOCK AVE
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-2324
Practice Address - Country:US
Practice Address - Phone:817-769-3670
Practice Address - Fax:817-769-3677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty