Provider Demographics
NPI:1407158066
Name:SMILE STRAIGHT ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:SMILE STRAIGHT ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZWICKY
Authorized Official - Suffix:
Authorized Official - Credentials:R
Authorized Official - Phone:480-866-8811
Mailing Address - Street 1:2817 W LOOP 250 N
Mailing Address - Street 2:B
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-3202
Mailing Address - Country:US
Mailing Address - Phone:432-694-4800
Mailing Address - Fax:432-694-4811
Practice Address - Street 1:2817 W LOOP 250 N
Practice Address - Street 2:B
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-3202
Practice Address - Country:US
Practice Address - Phone:432-694-4800
Practice Address - Fax:432-694-4811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX250431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty