Provider Demographics
NPI:1336457464
Name:SMILEY DENTAL NORTHLINE PLLC
Entity Type:Organization
Organization Name:SMILEY DENTAL NORTHLINE PLLC
Other - Org Name:SMILEY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNH
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-718-7880
Mailing Address - Street 1:PO BOX 453247
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75045-3247
Mailing Address - Country:US
Mailing Address - Phone:214-718-7880
Mailing Address - Fax:
Practice Address - Street 1:4400 NORTH FWY
Practice Address - Street 2:SPC D500
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-3604
Practice Address - Country:US
Practice Address - Phone:214-718-7880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty