Provider Demographics
NPI:1104094077
Name:GR8 SMILES ORTHODONTICS
Entity type:Organization
Organization Name:GR8 SMILES ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BORKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:972-242-2345
Mailing Address - Street 1:2440 N JOSEY LN
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-1668
Mailing Address - Country:US
Mailing Address - Phone:972-242-2345
Mailing Address - Fax:972-446-0450
Practice Address - Street 1:2440 N JOSEY LN
Practice Address - Street 2:SUITE # 201
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-1668
Practice Address - Country:US
Practice Address - Phone:972-242-2345
Practice Address - Fax:972-446-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty