Provider Demographics
NPI:1376819052
Name:SMILE WORKSHOP SAN ANTONIO, PLLC
Entity Type:Organization
Organization Name:SMILE WORKSHOP SAN ANTONIO, PLLC
Other - Org Name:IDEAL DENTAL WESTOVER HILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SULMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-331-8079
Mailing Address - Street 1:PO BOX 840925
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0925
Mailing Address - Country:US
Mailing Address - Phone:214-757-4500
Mailing Address - Fax:214-757-4501
Practice Address - Street 1:119 SW LOOP 410
Practice Address - Street 2:109
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-2107
Practice Address - Country:US
Practice Address - Phone:210-520-8338
Practice Address - Fax:210-520-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty