Provider Demographics
NPI:1679018923
Name:SMILEY STAR DENTAL PLLC
Entity Type:Organization
Organization Name:SMILEY STAR DENTAL PLLC
Other - Org Name:PARIS CHILDREN'S DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-905-4905
Mailing Address - Street 1:4300 LAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462
Mailing Address - Country:US
Mailing Address - Phone:903-905-4905
Mailing Address - Fax:903-905-4904
Practice Address - Street 1:4300 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462
Practice Address - Country:US
Practice Address - Phone:903-905-4905
Practice Address - Fax:903-905-4904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26555122300000X
122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty