Provider Demographics
NPI:1891968624
Name:SMILE BUILDERS DENTAL CENTER PC
Entity Type:Organization
Organization Name:SMILE BUILDERS DENTAL CENTER PC
Other - Org Name:SMILE BUILDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:JERNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-431-3727
Mailing Address - Street 1:4807 MAPLE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-1006
Mailing Address - Country:US
Mailing Address - Phone:214-431-3727
Mailing Address - Fax:214-260-6729
Practice Address - Street 1:4807 MAPLE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-1006
Practice Address - Country:US
Practice Address - Phone:214-431-3727
Practice Address - Fax:214-260-6729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-13
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty