Provider Demographics
NPI:1285394783
Name:SHARED SMILES PLLC
Entity type:Organization
Organization Name:SHARED SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLITOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:214-733-7002
Mailing Address - Street 1:6000 BRIARWOOD AVE APT B301
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-6044
Mailing Address - Country:US
Mailing Address - Phone:214-733-7002
Mailing Address - Fax:
Practice Address - Street 1:1702 W FM 700
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-4120
Practice Address - Country:US
Practice Address - Phone:432-267-4521
Practice Address - Fax:432-267-4943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty