Provider Demographics
NPI:1790094043
Name:SMILERX, PA
Entity Type:Organization
Organization Name:SMILERX, PA
Other - Org Name:SMILERX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:702-738-5334
Mailing Address - Street 1:PO BOX 8171
Mailing Address - Street 2:
Mailing Address - City:HORSESHOE BAY
Mailing Address - State:TX
Mailing Address - Zip Code:78657-8171
Mailing Address - Country:US
Mailing Address - Phone:702-738-5334
Mailing Address - Fax:
Practice Address - Street 1:102 ESTRELLA
Practice Address - Street 2:
Practice Address - City:HORSESHOE BAY
Practice Address - State:TX
Practice Address - Zip Code:78657
Practice Address - Country:US
Practice Address - Phone:702-738-5334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1208795Medicaid