Organization Name: | SMILES DENTAL GROUP, PC |
NPI Number: | 1295149334 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JACOB A LEWIS (CFO) |
Mailing Address: | 1018 N Boones Ferry Rd Woodburn |
State: | OR US |
Postal Code: | 970719602 |
Phone Number: | 5039811841 |
Fax Number: | 5039817334 |
NPI Enumeration Date: | 06/17/2014 |
NPI Last Update Date: | 06/17/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332BC3200X |
License Number: | D8230 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | Customized Equipment |
Taxonomy Definition: |