| Organization Name: | HEALTHY SMILES, INC. |
| NPI Number: | 1861720245 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHANNON MARIE KRUCKEBERG (EXECUTIVE DIRECTOR) |
| Mailing Address: | 63407 130th Ave Claremont |
| State: | MN US |
| Postal Code: | 559244656 |
| Phone Number: | 5073196845 |
| Fax Number: | |
| NPI Enumeration Date: | 11/24/2009 |
| NPI Last Update Date: | 11/24/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251V00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Voluntary or Charitable |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |