Provider Demographics
NPI:1700429339
Name:SMILE EXPRESS FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SMILE EXPRESS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:UWADIAE
Authorized Official - Middle Name:
Authorized Official - Last Name:UYIGUE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-427-9976
Mailing Address - Street 1:9307 CAGLE DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-1391
Mailing Address - Country:US
Mailing Address - Phone:720-427-9976
Mailing Address - Fax:
Practice Address - Street 1:443 S BROADWAY ST UNIT A
Practice Address - Street 2:
Practice Address - City:JOSHUA
Practice Address - State:TX
Practice Address - Zip Code:76058-3199
Practice Address - Country:US
Practice Address - Phone:720-427-9976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-27
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental