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Organization
SMILE & AESTHETICS 360 DENTAL & MEDSPA
Active
Organization
SMILE & AESTHETICS 360 DENTAL & MEDSPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUVERIA FAKHRUDDIN (DENTIST)
(219) 308-7221
Entity
Organization
Contact information
Practice address
12606 GREENVILLE AVE STE 230, DALLAS, TX 75243-1921
(219) 308-7221
Mailing address
708 NICKELVILLE LN, WYLIE, TX 75098-5395
(219) 308-7221
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
06/25/2024
Last updated
03/11/2025
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