Provider Demographics
NPI:1316759350
Name:SACRED SMILES PLLC
Entity type:Organization
Organization Name:SACRED SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JUNIOR
Authorized Official - Middle Name:
Authorized Official - Last Name:TOBIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-909-1769
Mailing Address - Street 1:7255 CANYON FALLS RD # 401
Mailing Address - Street 2:
Mailing Address - City:NORTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-4543
Mailing Address - Country:US
Mailing Address - Phone:214-909-1769
Mailing Address - Fax:
Practice Address - Street 1:7251 CANYON FALLS RD # 401
Practice Address - Street 2:
Practice Address - City:NORTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76226-4543
Practice Address - Country:US
Practice Address - Phone:214-432-7180
Practice Address - Fax:214-432-7190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment