Provider Demographics
NPI:1902042500
Name:SMILE CENTER DENTAL PA
Entity Type:Organization
Organization Name:SMILE CENTER DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-648-7600
Mailing Address - Street 1:907 S WW WHITE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78220-2528
Mailing Address - Country:US
Mailing Address - Phone:210-648-7600
Mailing Address - Fax:
Practice Address - Street 1:907 S WW WHITE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78220-2528
Practice Address - Country:US
Practice Address - Phone:210-648-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty