Provider Demographics
NPI:1962702910
Name:SMILES FOR SCHOOLS
Entity type:Organization
Organization Name:SMILES FOR SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TESCH
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:512-627-2668
Mailing Address - Street 1:902 CLEARWATER CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-2404
Mailing Address - Country:US
Mailing Address - Phone:512-627-2668
Mailing Address - Fax:
Practice Address - Street 1:902 CLEARWATER CIR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-2404
Practice Address - Country:US
Practice Address - Phone:512-627-2668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95331223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130641707Medicaid