Provider Demographics
NPI:1497112551
Name:MILA DAVIS DDS, PC
Entity Type:Organization
Organization Name:MILA DAVIS DDS, PC
Other - Org Name:HEALTHY SMILES CHILDREN'S DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-436-4774
Mailing Address - Street 1:12398 FM 423
Mailing Address - Street 2:SUITE 1900
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-4758
Mailing Address - Country:US
Mailing Address - Phone:214-436-4774
Mailing Address - Fax:214-436-4775
Practice Address - Street 1:12398 FM 423
Practice Address - Street 2:SUITE 1900
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4758
Practice Address - Country:US
Practice Address - Phone:214-436-4774
Practice Address - Fax:214-436-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX23502Medicaid