Provider Demographics
NPI:1992088579
Name:HEALTHY SMILES PLLC
Entity type:Organization
Organization Name:HEALTHY SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-581-7000
Mailing Address - Street 1:1123 E. 9TH ST.
Mailing Address - Street 2:SUITE 10-A
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572
Mailing Address - Country:US
Mailing Address - Phone:956-581-7000
Mailing Address - Fax:
Practice Address - Street 1:1123 E 9TH ST
Practice Address - Street 2:SUITE 10-A
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-4404
Practice Address - Country:US
Practice Address - Phone:956-581-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA260241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2155822Medicaid