Organization
MY SMILE ARTIST, PLLC
Active
Other names
my smile artist
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMED IMAM DDS, BDS (DENTIST)
(210) 496-9967
Entity
Organization
Contact information
Practice address
1130 E SONTERRA BLVD STE 110, SAN ANTONIO, TX 78258-4236
(210) 496-9967
Mailing address
1130 E SONTERRA BLVD STE 110, SAN ANTONIO, TX 78258-4236
(210) 496-9967
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1770677445
NPI
TX
Enumeration date
10/10/2019
Last updated
10/10/2019
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