Provider Demographics
NPI:1326461492
Name:H2 ORTHODONTICS, PLLC
Entity Type:Organization
Organization Name:H2 ORTHODONTICS, PLLC
Other - Org Name:SMILE MAKERS ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:HUMBERT
Authorized Official - Last Name:HSU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:972-722-2943
Mailing Address - Street 1:3090 N GOLIAD ST STE 106
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-7049
Mailing Address - Country:US
Mailing Address - Phone:972-722-2943
Mailing Address - Fax:972-722-2978
Practice Address - Street 1:3090 N GOLIAD ST STE 106
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-7049
Practice Address - Country:US
Practice Address - Phone:972-722-2943
Practice Address - Fax:972-722-2978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX286191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1891074472Medicaid