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Organization
SMILE DENTAL PLLC
Active
Organization
SMILE DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELYN DO DDS (OWNER/DENTIST)
(281) 485-1133
Entity
Organization
Contact information
Practice address
3525 BROADWAY STREET, SUITE 101, PEARLAND, TX 77581
(281) 485-1133
(281) 485-1166
Mailing address
3525 BROADWAY STREET, SUITE 101, PEARLAND, TX 77581
(281) 485-1133
(281) 485-1166
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
23838
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D53206
MEDICAL PROVIDER IDENTIFICATION
CA
Enumeration date
05/08/2009
Last updated
09/14/2009
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