Provider Demographics
NPI:1821549130
Name:SD-HWY 78 PC
Entity Type:Organization
Organization Name:SD-HWY 78 PC
Other - Org Name:SMILEY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNHTHY
Authorized Official - Middle Name:THY
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-466-1400
Mailing Address - Street 1:10901 GARLAND RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-2613
Mailing Address - Country:US
Mailing Address - Phone:214-466-1400
Mailing Address - Fax:214-367-5896
Practice Address - Street 1:6735 FM 78
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-1367
Practice Address - Country:US
Practice Address - Phone:210-667-2929
Practice Address - Fax:210-661-2575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty