Provider Demographics
NPI:1679817001
Name:SMILE AVENUE FAMILY DENTAL
Entity type:Organization
Organization Name:SMILE AVENUE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:KEELYN
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-824-3043
Mailing Address - Street 1:1591 E HIGHWAY 6
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-6045
Mailing Address - Country:US
Mailing Address - Phone:281-824-3043
Mailing Address - Fax:281-605-5578
Practice Address - Street 1:1591 E HIGHWAY 6
Practice Address - Street 2:SUITE 109
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-6045
Practice Address - Country:US
Practice Address - Phone:281-824-3043
Practice Address - Fax:281-605-5578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21495261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental