Provider Demographics
NPI:1962223966
Name:TEEFAB SMILES DENTAL PLLC
Entity type:Organization
Organization Name:TEEFAB SMILES DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIWALADE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABIDOYE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-445-3465
Mailing Address - Street 1:430 E LAMAR BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-3600
Mailing Address - Country:US
Mailing Address - Phone:323-445-3465
Mailing Address - Fax:
Practice Address - Street 1:430 E LAMAR BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-3600
Practice Address - Country:US
Practice Address - Phone:323-445-3465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty