Provider Demographics
NPI:1871248625
Name:MESQUITE SMILE CENTER PLLC
Entity Type:Organization
Organization Name:MESQUITE SMILE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:HANH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-418-0209
Mailing Address - Street 1:3220 GUS THOMASSON RD STE 347
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4051
Mailing Address - Country:US
Mailing Address - Phone:972-698-6685
Mailing Address - Fax:
Practice Address - Street 1:3220 GUS THOMASSON RD STE 347
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4051
Practice Address - Country:US
Practice Address - Phone:972-698-6685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty