Provider Demographics
NPI:1972839397
Name:SMILE MAGIC OF DENTON, PLLC
Entity Type:Organization
Organization Name:SMILE MAGIC OF DENTON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF DENTAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:940-808-1917
Mailing Address - Street 1:PO BOX 674330
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267
Mailing Address - Country:US
Mailing Address - Phone:855-697-6453
Mailing Address - Fax:855-731-5147
Practice Address - Street 1:3600 E. MCKINNEY ST, SUITE 190
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209
Practice Address - Country:US
Practice Address - Phone:940-387-2442
Practice Address - Fax:340-387-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty