# FORT WORTH SMILE STUDIO P.L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922499482
- **Authorized official:** DR. MARIO MIRANDA D.D.S (DENTIST)
- **Authorized official phone:** (817) 263-9014

## Contact information

- **Practice address:** 6115 S HULEN ST, FORT WORTH, TX 76133-3403
- **Practice address phone:** (817) 236-9014
- **Practice address fax:** (817) 263-7081
- **Mailing address:** 6115 S HULEN ST, FORT WORTH, TX 76133-3403
- **Mailing address phone:** (817) 236-9014
- **Mailing address fax:** (817) 263-7081

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 02/05/2015
- **Last updated:** 02/05/2015