Provider Demographics
NPI:1952906604
Name:TIDWELL SMILES PLLC
Entity Type:Organization
Organization Name:TIDWELL SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-369-6775
Mailing Address - Street 1:3838 N SAM HOUSTON PKWY E STE 430
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77032-3418
Mailing Address - Country:US
Mailing Address - Phone:832-369-6775
Mailing Address - Fax:682-222-1093
Practice Address - Street 1:9415 MESA DR STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77028-1202
Practice Address - Country:US
Practice Address - Phone:832-369-6775
Practice Address - Fax:682-222-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty