Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Dental |
261QD0000X | |||
Dental Public Health |
1223D0001X |
| NPI Number | 1871369298 |
| LBN Legal business name | THE SMILE FACTORY MOBILE CLINIC LLC |
| Authorized official | SHERONTA JOHNSON - (OWNER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 11/27/2023 |
| Last updated | 11/27/2023 - About 3 years ago |
| Identifiers | n/a |
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