Provider Demographics
NPI:1992028377
Name:FORT WORTH SMILES BY WIRE, PLLC
Entity Type:Organization
Organization Name:FORT WORTH SMILES BY WIRE, PLLC
Other - Org Name:ALL SMILES DENTAL & ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CODEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-342-5757
Mailing Address - Street 1:4901 LBJ FREEWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-6158
Mailing Address - Country:US
Mailing Address - Phone:214-342-5757
Mailing Address - Fax:
Practice Address - Street 1:9090 SKILLMAN ST
Practice Address - Street 2:200C
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-8259
Practice Address - Country:US
Practice Address - Phone:214-342-5757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALL SMILES DENTAL PROFESSIONALS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-12
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX162061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty