Provider Demographics
NPI:1396360707
Name:REAL SMILES, LLC
Entity Type:Organization
Organization Name:REAL SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-847-9901
Mailing Address - Street 1:604 E BAILEY BOSWELL RD STE 150
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76131-3574
Mailing Address - Country:US
Mailing Address - Phone:817-847-9901
Mailing Address - Fax:
Practice Address - Street 1:604 E BAILEY BOSWELL RD STE 150
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76131-3574
Practice Address - Country:US
Practice Address - Phone:817-847-9901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty