Organization
BROADMOOR SRG PLLC
Active
Other names
Smile Heroes Dental
Organization subpart
No
Provider details
NPI number
Authorized official
NINA ABTAHI (MANAGER)
(214) 493-1216
Entity
Organization
Contact information
Practice address
500 N GALLOWAY AVE STE 6, MESQUITE, TX 75149-4338
(214) 493-1216
Mailing address
500 N GALLOWAY AVE STE 6, MESQUITE, TX 75149-4338
(214) 493-1216
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223G0001X
General Practice Dentistry
—
—
Other
Enumeration date
03/31/2022
Last updated
10/12/2022
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