Provider Demographics
NPI:1790534592
Name:DR. SMILEE-KILLEEN, LLC
Entity type:Organization
Organization Name:DR. SMILEE-KILLEEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONG HYUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:254-732-2606
Mailing Address - Street 1:1230 N VALLEY MILLS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-4402
Mailing Address - Country:US
Mailing Address - Phone:254-732-2606
Mailing Address - Fax:
Practice Address - Street 1:1001 S FORT HOOD ST STE 1001-B
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-7448
Practice Address - Country:US
Practice Address - Phone:214-578-3047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty