Provider Demographics
NPI:1366642217
Name:SMILEY DENTAL-GRAND PRAIRIE PLLC
Entity Type:Organization
Organization Name:SMILEY DENTAL-GRAND PRAIRIE 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:T
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-718-2786
Mailing Address - Street 1:117 N BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-5800
Mailing Address - Country:US
Mailing Address - Phone:972-262-1395
Mailing Address - Fax:
Practice Address - Street 1:117 N BELT LINE RD
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5800
Practice Address - Country:US
Practice Address - Phone:972-262-1395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty