Organization
TPD SMILES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMBER BROOKS (BUSINESS MANAGER)
(972) 542-6662
Entity
Organization
Contact information
Practice address
3575 LAKOTA TRL STE 200, MCKINNEY, TX 75070-3601
(972) 542-6662
Mailing address
3575 LAKOTA TRL STE 200, MCKINNEY, TX 75070-3601
(972) 542-6662
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
12/17/2020
Last updated
12/17/2020
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