Provider Demographics
NPI:1063198620
Name:SM DENTAL PLLC
Entity type:Organization
Organization Name:SM DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JIHOON
Authorized Official - Middle Name:
Authorized Official - Last Name:SON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-655-8827
Mailing Address - Street 1:13920 RONALD REAGAN BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641
Mailing Address - Country:US
Mailing Address - Phone:737-777-6226
Mailing Address - Fax:
Practice Address - Street 1:13920 RONALD REAGAN BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641
Practice Address - Country:US
Practice Address - Phone:737-777-6226
Practice Address - Fax:737-777-6220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental