Provider Demographics
NPI:1528211406
Name:JACKSBORO SMILES BY WIRE, PLLC
Entity Type:Organization
Organization Name:JACKSBORO SMILES BY WIRE, PLLC
Other - Org Name:ALL SMILES DENTAL & ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CODEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-342-5757
Mailing Address - Street 1:4901 LBJ FREEWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-6158
Mailing Address - Country:US
Mailing Address - Phone:214-342-5757
Mailing Address - Fax:214-389-5844
Practice Address - Street 1:2480 JACKSBORO HWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76114-2201
Practice Address - Country:US
Practice Address - Phone:817-529-0994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty