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Organization
REAL SMILES
Active
Organization
REAL SMILES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAFFY KOUYOUMDJIAN D.M.D (CEO)
(818) 653-9799
Entity
Organization
Contact information
Practice address
3330 MANSFIELD HWY STE B, FORT WORTH, TX 76119
(818) 653-9799
Mailing address
3839 MCKINNEY AVE APT 403, DALLAS, TX 75204-1417
(818) 653-9799
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
23066
TX
1223G0001X
General Practice Dentistry
Primary
23066
TX
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
05/13/2008
Last updated
05/13/2008
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