NPIMap

Organization Active NPI

Great Expression Smiles

  • Preferred Provider Organization
  • Fort Worth, TX
National Provider Identifier
1235540253
Registry record updated May 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
Legal business name
GREAT EXPRESSION SMILES
Practice address
6426 Meadowbrook Dr
Fort Worth, TX 76112-5123
Phone
(817) 496-2343
Fax
(817) 665-3822
NPI assigned
May 13, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X Primary

Addresses

Primary practice location

6426 Meadowbrook Dr
Fort Worth, TX 76112-5123

Mailing address

2501 W Interstate 20 Ste 100
Grand Prairie, TX 75052-3948
Phone (817) 496-2343

Other identifiers 1

IdentifierTypeStateIssuer
202009121MedicaidTX

Other names 1

  • Great Expression Smiles Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Great Expression Smiles4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1399939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399939200000",
    "number": "1235540253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 W INTERSTATE 20 STE 100",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750523948",
            "telephone_number": "817-496-2343",
            "fax_number": "817-665-3822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6426 MEADOWBROOK DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761125123",
            "telephone_number": "817-496-2343",
            "fax_number": "817-665-3822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT EXPRESSION SMILES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-13",
        "last_updated": "2014-05-13",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "TRI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-496-2343",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202009121",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Expression Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.