Provider Demographics
NPI:1013278779
Name:BROWNWOOD SMILECRAFTERS, PLLC
Entity Type:Organization
Organization Name:BROWNWOOD SMILECRAFTERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:HANSEN
Authorized Official - Last Name:BAYLESS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:325-673-8164
Mailing Address - Street 1:3709 AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-6626
Mailing Address - Country:US
Mailing Address - Phone:325-646-0516
Mailing Address - Fax:
Practice Address - Street 1:3709 AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-6626
Practice Address - Country:US
Practice Address - Phone:325-646-0516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208670402Medicaid