Provider Demographics
NPI:1780898924
Name:DR. SMILE DENTISTRY, P.A.
Entity type:Organization
Organization Name:DR. SMILE DENTISTRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THUONG
Authorized Official - Middle Name:DOMINIC
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-467-8007
Mailing Address - Street 1:6800 ALMA DR
Mailing Address - Street 2:SUITE #101
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-2006
Mailing Address - Country:US
Mailing Address - Phone:469-467-8007
Mailing Address - Fax:469-467-8011
Practice Address - Street 1:6800 ALMA DR
Practice Address - Street 2:SUITE #101
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-2006
Practice Address - Country:US
Practice Address - Phone:469-467-8007
Practice Address - Fax:469-467-8011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD205831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1341891OtherUNITED CONCORDIA
TX147438901Medicaid
TXB20583-01OtherTX-CHIP