Provider Demographics
NPI:1578892733
Name:GOODSMILES DENTAL, PLLC
Entity Type:Organization
Organization Name:GOODSMILES DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:408-431-7258
Mailing Address - Street 1:3212 PAMPLONA
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6859
Mailing Address - Country:US
Mailing Address - Phone:408-431-7258
Mailing Address - Fax:
Practice Address - Street 1:2535 E ARKANSAS LN
Practice Address - Street 2:SUITE 339-341
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-8797
Practice Address - Country:US
Practice Address - Phone:408-431-7258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty