Organization
SMILES OF FORT WORTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESUS ALVARADO (OFFICE MANAGER)
(814) 457-4078
Entity
Organization
Contact information
Practice address
5601 BRIDGE ST STE 480, FORT WORTH, TX 76112-2351
(817) 457-4078
Mailing address
PO BOX 4400, SALEM, OR 97302-8400
(817) 457-4078
(817) 798-8912
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/15/2019
Last updated
07/15/2019
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