Basic Information
Provider Information | |||||||||
NPI: | 1427222926 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ST. FRANCIS SMILES, PLLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ALL SMILES DENTAL & ORTHODONTICS | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4901 LBJ FREEWAY | ||||||||
Address2: | SUITE 400 | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 752446158 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2143425757 | ||||||||
FaxNumber: | 2143404868 | ||||||||
Practice Location | |||||||||
Address1: | 8928 E RL THRTN FWY | ||||||||
Address2: | # 106 | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 752286173 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2143899858 | ||||||||
FaxNumber: | 2143899862 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/15/2008 | ||||||||
LastUpdateDate: | 02/16/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CODEL | ||||||||
AuthorizedOfficialFirstName: | ADRIAN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
AuthorizedOfficialTelephone: | 2143425757 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | DDS | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics | 1223G0001X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.