Provider Demographics
NPI:1174086284
Name:GROWING SMILES OF ANNA PLLC
Entity type:Organization
Organization Name:GROWING SMILES OF ANNA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:RAGHID
Authorized Official - Last Name:ALOLABI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-501-2721
Mailing Address - Street 1:3610 SHIRE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2239
Mailing Address - Country:US
Mailing Address - Phone:214-501-2721
Mailing Address - Fax:
Practice Address - Street 1:2530 W WHITE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-7508
Practice Address - Country:US
Practice Address - Phone:214-501-2721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty