Provider Demographics
NPI:1215266093
Name:ABILENE SMILECRAFTERS, PLLC
Entity type:Organization
Organization Name:ABILENE SMILECRAFTERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:HANSEN
Authorized Official - Last Name:BAYLESS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:325-673-8164
Mailing Address - Street 1:1034 N WILLIS ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79603-4622
Mailing Address - Country:US
Mailing Address - Phone:325-673-8164
Mailing Address - Fax:325-673-0812
Practice Address - Street 1:1034 N WILLIS ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-4622
Practice Address - Country:US
Practice Address - Phone:325-673-8164
Practice Address - Fax:325-673-0812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty