Provider Demographics
NPI:1740685957
Name:SMILEY TOOTH LLLP
Entity type:Organization
Organization Name:SMILEY TOOTH LLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHOU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-772-7553
Mailing Address - Street 1:2014 S GOLIAD ST STE 122
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-4864
Mailing Address - Country:US
Mailing Address - Phone:972-772-7553
Mailing Address - Fax:
Practice Address - Street 1:2014 S GOLIAD ST STE 122
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4864
Practice Address - Country:US
Practice Address - Phone:972-772-7553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197101201Medicaid
TX321814101Medicaid