Provider Demographics
NPI:1558540823
Name:SMILE TEXAS, LLC
Entity Type:Organization
Organization Name:SMILE TEXAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DENTAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:888-833-8441
Mailing Address - Street 1:PO BOX 250310
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-0310
Mailing Address - Country:US
Mailing Address - Phone:888-833-8441
Mailing Address - Fax:888-330-4331
Practice Address - Street 1:5430 LBJ FWY
Practice Address - Street 2:SUITE 1200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-2601
Practice Address - Country:US
Practice Address - Phone:888-833-8441
Practice Address - Fax:888-330-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty