Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Dental |
261QD0000X | |||
Dentist |
122300000X |
| NPI # | 1659447688 |
||||
| LBN Legal business name | HEALTHY SMILES FAMILY DENTISTRY INC | ||||
| Authorized official | MARLENA BOOTH - (CEO) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 11/28/2006 | ||||
| Last updated | 10/12/2007 - About 19 years ago | ||||
| Identifiers |
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