Provider Demographics
NPI:1134957459
Name:SECOND IMPRESSION SMILES, PLLC
Entity type:Organization
Organization Name:SECOND IMPRESSION SMILES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TANAYA
Authorized Official - Middle Name:CLAIBORNE
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-929-4728
Mailing Address - Street 1:1705 FOUNTAINVIEW DR STE 105
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7808
Mailing Address - Country:US
Mailing Address - Phone:682-232-4335
Mailing Address - Fax:
Practice Address - Street 1:1705 FOUNTAINVIEW DR STE 105
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7808
Practice Address - Country:US
Practice Address - Phone:682-232-4335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1568782274OtherALIX H. SANDERS JR. DDS