Provider Demographics
NPI:1689951196
Name:MOBILE SMILES OF TEXAS
Entity Type:Organization
Organization Name:MOBILE SMILES OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:WINDHAM SHIRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:936-554-0996
Mailing Address - Street 1:6107 MARTEL AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3025
Mailing Address - Country:US
Mailing Address - Phone:936-554-0669
Mailing Address - Fax:936-598-6412
Practice Address - Street 1:6107 MARTEL AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3025
Practice Address - Country:US
Practice Address - Phone:936-554-0996
Practice Address - Fax:936-598-6412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental