Provider Demographics
NPI:1750601548
Name:SMILE MAGIC OF LEWISVILLE, PLLC
Entity type:Organization
Organization Name:SMILE MAGIC OF LEWISVILLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-387-2442
Mailing Address - Street 1:PO BOX 674330
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4330
Mailing Address - Country:US
Mailing Address - Phone:940-808-1940
Mailing Address - Fax:
Practice Address - Street 1:2470 S STEMMONS FWY
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8755
Practice Address - Country:US
Practice Address - Phone:940-808-1940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty