Provider Demographics
NPI:1598007569
Name:LASER SMILE STUDIO
Entity Type:Organization
Organization Name:LASER SMILE STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:MCCRACKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:940-891-0663
Mailing Address - Street 1:2215 S LOOP 288
Mailing Address - Street 2:SUITE 406
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-4981
Mailing Address - Country:US
Mailing Address - Phone:940-891-0663
Mailing Address - Fax:940-484-4949
Practice Address - Street 1:2215 S LOOP 288
Practice Address - Street 2:SUITE 406
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-4981
Practice Address - Country:US
Practice Address - Phone:940-891-0663
Practice Address - Fax:940-484-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty