Provider Demographics
NPI:1013472075
Name:ALLSMILES PA
Entity type:Organization
Organization Name:ALLSMILES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELESTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSAKWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-334-8303
Mailing Address - Street 1:2106 PECAN GROVE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-2876
Mailing Address - Country:US
Mailing Address - Phone:214-334-8303
Mailing Address - Fax:
Practice Address - Street 1:2106 PECAN GROVE DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-2876
Practice Address - Country:US
Practice Address - Phone:214-334-8303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6325Medicaid