Provider Demographics
NPI:1497280408
Name:JS PEDODONTICS PLLC
Entity Type:Organization
Organization Name:JS PEDODONTICS PLLC
Other - Org Name:SOARING SMILES PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:251-786-2011
Mailing Address - Street 1:3555 NATIONAL DRIVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025
Mailing Address - Country:US
Mailing Address - Phone:251-786-2011
Mailing Address - Fax:
Practice Address - Street 1:3555 NATIONAL DRIVE
Practice Address - Street 2:STE. 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025
Practice Address - Country:US
Practice Address - Phone:251-786-2011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX290831223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty