Provider Demographics
NPI:1508399536
Name:SUPERSTAR SMILES DENTAL & ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:SUPERSTAR SMILES DENTAL & ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MALOUF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-785-3290
Mailing Address - Street 1:10711 STRAIT LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-5428
Mailing Address - Country:US
Mailing Address - Phone:817-785-3290
Mailing Address - Fax:682-292-1502
Practice Address - Street 1:930 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3516
Practice Address - Country:US
Practice Address - Phone:214-253-2402
Practice Address - Fax:682-292-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty