Provider Demographics
NPI:1578045969
Name:CLEAR SMILE DOCS, PLLC
Entity Type:Organization
Organization Name:CLEAR SMILE DOCS, PLLC
Other - Org Name:CLEAR SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-460-5915
Mailing Address - Street 1:1919 MCKINNEY AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1753
Mailing Address - Country:US
Mailing Address - Phone:469-460-5915
Mailing Address - Fax:
Practice Address - Street 1:1919 MCKINNEY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-1753
Practice Address - Country:US
Practice Address - Phone:469-460-5915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13073261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental