Provider Demographics
NPI:1639674179
Name:GROWING SMILES CONWAY
Entity Type:Organization
Organization Name:GROWING SMILES CONWAY
Other - Org Name:GROWING SMILES CHILDREN'S DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:NASSER
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-664-2244
Mailing Address - Street 1:6800 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3293
Mailing Address - Country:US
Mailing Address - Phone:956-664-2244
Mailing Address - Fax:956-664-9355
Practice Address - Street 1:4209 N CONWAY AVE STE F
Practice Address - Street 2:
Practice Address - City:PALMHURST
Practice Address - State:TX
Practice Address - Zip Code:78573-1482
Practice Address - Country:US
Practice Address - Phone:956-664-2244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX222261223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty