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Organization
GREAT EXPRESSION SMILES
Active
Organization
GREAT EXPRESSION SMILES
Active
Other names
Great Expression Smiles
Organization subpart
No
Provider details
NPI number
Authorized official
TRI PHAM DDS (PRESIDENT)
(817) 496-2343
Entity
Organization
Contact information
Practice address
6426 MEADOWBROOK DR, FORT WORTH, TX 76112-5123
(817) 496-2343
(817) 665-3822
Mailing address
2501 W INTERSTATE 20 STE 100, GRAND PRAIRIE, TX 75052-3948
(817) 496-2343
(817) 665-3822
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202009121
—
TX
Enumeration date
05/13/2014
Last updated
05/13/2014
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