Provider Demographics
NPI:1336439165
Name:CEDAR PARK SMILES, PLLC
Entity Type:Organization
Organization Name:CEDAR PARK SMILES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:512-219-1389
Mailing Address - Street 1:100 N LAKELINE BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-6798
Mailing Address - Country:US
Mailing Address - Phone:512-219-1389
Mailing Address - Fax:512-219-0725
Practice Address - Street 1:100 N LAKELINE BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6798
Practice Address - Country:US
Practice Address - Phone:512-219-1389
Practice Address - Fax:512-219-0725
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEVEN W SMITH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15539261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental