Provider Demographics
NPI:1255671277
Name:SMILE CONCEPTS PA
Entity type:Organization
Organization Name:SMILE CONCEPTS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-561-7647
Mailing Address - Street 1:2200 TRENTON RD
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6354
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 TRENTON RD
Practice Address - Street 2:SUITE 3A
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6354
Practice Address - Country:US
Practice Address - Phone:800-868-9908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27351122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty