Provider Demographics
NPI:1346905817
Name:SMILE BLVD., PLLC
Entity Type:Organization
Organization Name:SMILE BLVD., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD1
Authorized Official - Phone:954-608-9984
Mailing Address - Street 1:660 W CAMPBELL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3396
Mailing Address - Country:US
Mailing Address - Phone:972-736-9843
Mailing Address - Fax:
Practice Address - Street 1:660 W CAMPBELL RD STE 101
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3396
Practice Address - Country:US
Practice Address - Phone:954-608-9984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty