Provider Demographics
NPI:1861789075
Name:SUMMER SMILES DENTAL AND ORTHODONTICS
Entity type:Organization
Organization Name:SUMMER SMILES DENTAL AND ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HSIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-608-8112
Mailing Address - Street 1:913 W. STACY ROAD
Mailing Address - Street 2:180
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013
Mailing Address - Country:US
Mailing Address - Phone:214-383-5562
Mailing Address - Fax:214-383-7601
Practice Address - Street 1:913 W. STACY ROAD, SUITE 180
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013
Practice Address - Country:US
Practice Address - Phone:214-608-8112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23573122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty