Provider Demographics
NPI:1639610181
Name:KA SMILE PLUS
Entity type:Organization
Organization Name:KA SMILE PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-893-2735
Mailing Address - Street 1:617 K AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-8533
Mailing Address - Country:US
Mailing Address - Phone:972-372-9170
Mailing Address - Fax:972-379-8115
Practice Address - Street 1:617 K AVE STE 300
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-8533
Practice Address - Country:US
Practice Address - Phone:972-372-9170
Practice Address - Fax:972-379-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX303851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty