1487199667 NPI number — MILLENNIUM SMILES

Table of content: (NPI 1487199667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487199667 NPI number — MILLENNIUM SMILES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILLENNIUM SMILES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487199667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8979 FM 423
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-987-4899
Provider Business Mailing Address Fax Number:
972-987-4915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8979 FARM TO MARKET RD 423 SUITE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
972-987-4899
Provider Business Practice Location Address Fax Number:
972-987-4915
Provider Enumeration Date:
12/27/2016

Additional Information

Authorized Official

Authorized Official Last Name:
KOROUS
Authorized Official First Name:
DUNIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/DENTIST
Authorized Official Telephone Number:
972-987-4899

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  28879 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1134566052 . This is a "HEALTH CARE INSURANCE COMPANIES" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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