Provider Demographics
NPI:1366406100
Name:SMILECRAFTERS PA
Entity type:Organization
Organization Name:SMILECRAFTERS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHANH
Authorized Official - Middle Name:QUOC
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-320-8709
Mailing Address - Street 1:18425 CHAMPION FOREST DRIVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379
Mailing Address - Country:US
Mailing Address - Phone:281-320-8709
Mailing Address - Fax:281-251-9226
Practice Address - Street 1:18425 CHAMPION FOREST DRIVE
Practice Address - Street 2:SUITE 220
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379
Practice Address - Country:US
Practice Address - Phone:281-320-8709
Practice Address - Fax:281-251-9226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19474122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty