Provider Demographics
NPI:1548487895
Name:1ST SMILE DENTAL, P.A.
Entity type:Organization
Organization Name:1ST SMILE DENTAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-467-7727
Mailing Address - Street 1:1515 COCKRELL HILL RD
Mailing Address - Street 2:A111
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-1315
Mailing Address - Country:US
Mailing Address - Phone:214-467-7727
Mailing Address - Fax:214-467-7743
Practice Address - Street 1:1515 COCKRELL HILL RD
Practice Address - Street 2:A111
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-1315
Practice Address - Country:US
Practice Address - Phone:214-467-7727
Practice Address - Fax:214-467-7743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty