Provider Demographics
NPI:1417651803
Name:DELTA DENTAL SMILE
Entity Type:Organization
Organization Name:DELTA DENTAL SMILE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:FARYAAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-999-3399
Mailing Address - Street 1:539 W COMMERCE ST # 6909
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-1953
Mailing Address - Country:US
Mailing Address - Phone:971-999-3399
Mailing Address - Fax:
Practice Address - Street 1:3125 CRESTDALE DR
Practice Address - Street 2:APT #2147
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080
Practice Address - Country:US
Practice Address - Phone:971-999-3399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental