Provider Demographics
NPI:1194152140
Name:SMILE HEROES, PLLC
Entity type:Organization
Organization Name:SMILE HEROES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:915-493-2699
Mailing Address - Street 1:700 N ZARAGOZA RD
Mailing Address - Street 2:SUITE T
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-4703
Mailing Address - Country:US
Mailing Address - Phone:915-493-2699
Mailing Address - Fax:
Practice Address - Street 1:700 N ZARAGOZA RD
Practice Address - Street 2:SUITE T
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-4703
Practice Address - Country:US
Practice Address - Phone:415-683-0963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-06
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27345122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty