Provider Demographics
NPI:1295495703
Name:32 SMILES DENTAL WELLNESS CENTER, PLLC
Entity type:Organization
Organization Name:32 SMILES DENTAL WELLNESS CENTER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:IQBAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:978-728-2351
Mailing Address - Street 1:2811 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-7047
Mailing Address - Country:US
Mailing Address - Phone:210-785-8526
Mailing Address - Fax:
Practice Address - Street 1:2811 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-7047
Practice Address - Country:US
Practice Address - Phone:210-785-8526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-23
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO351923464Medicaid
CA024795140Medicaid