NPI 1235540253

Great Expression Smiles

Organisation Preferred Provider Organization Fort Worth, TX

Practice location

Address: 6426 Meadowbrook Dr, Fort Worth, TX 76112-5123
Phone: (817) 496-2343
Fax: (817) 665-3822
Mailing address: 2501 W Interstate 20 STE 100, Grand Prairie, TX 75052-3948

Authorised official

Name: Tri Pham
Title: President
Phone: (817) 496-2343

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X

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Registry record

NPI: 1235540253
Entity type: Organization
NPI issued: 13 May 2014
Record last updated: 13 May 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.