Provider Demographics
NPI:1760646723
Name:SMILE DENTAL CARE PA
Entity Type:Organization
Organization Name:SMILE DENTAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHANH
Authorized Official - Middle Name:A
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-241-1962
Mailing Address - Street 1:13260 JOSEY LN
Mailing Address - Street 2:STE# 101
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-4973
Mailing Address - Country:US
Mailing Address - Phone:972-241-1962
Mailing Address - Fax:972-241-2339
Practice Address - Street 1:13260 JOSEY LN
Practice Address - Street 2:STE# 101
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-4973
Practice Address - Country:US
Practice Address - Phone:972-241-1962
Practice Address - Fax:972-241-2339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19801122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty