| Smile Pro Dentistry | |
|
3013 E Main Ave Ste B Alton TX 78573-0932 | |
| (956) 583-0135 | |
| (956) 583-0886 |
| Full Name | Smile Pro Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 3013 E Main Ave Ste B, Alton, Texas |
| Authorized Official Name and Position | Jaser Diaz (OWNER) |
| Authorized Official Contact | 9565830135 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Smile Pro Dentistry 3013 E Main Ave Ste B Alton TX 78573-0932 Ph: (956) 583-0135 | Smile Pro Dentistry 3013 E Main Ave Ste B Alton TX 78573-0932 Ph: (956) 583-0135 |
| NPI Number | 1366780777 |
|---|---|
| Provider Enumeration Date | 01/18/2013 |
| Last Update Date | 06/13/2024 |
| Medicare PECOS PAC ID | 6204197155 |
|---|---|
| Medicare Enrollment ID | O20180309001773 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366780777 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 24685 (Texas) | Primary |
| Provider Name | Jaser Diaz |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1548490220 PECOS PAC ID: 1355602202 Enrollment ID: I20180313000109 |
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