Provider Demographics
NPI:1598959819
Name:PEDIATRIC DENTISTRY FOR SMALL SMILES, P.A.
Entity Type:Organization
Organization Name:PEDIATRIC DENTISTRY FOR SMALL SMILES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TY
Authorized Official - Middle Name:
Authorized Official - Last Name:HINZE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-441-2698
Mailing Address - Street 1:1631 ANTIQUE LN
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-6760
Mailing Address - Country:US
Mailing Address - Phone:469-441-2698
Mailing Address - Fax:
Practice Address - Street 1:5971 VIRGINIA PARKWAY, STE. 300
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071
Practice Address - Country:US
Practice Address - Phone:469-441-2698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty