Provider Demographics
NPI:1003955717
Name:ALL SMILEZ, INC.
Entity Type:Organization
Organization Name:ALL SMILEZ, INC.
Other - Org Name:ALL SMILEZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, ALL SMILEZ, INC.
Authorized Official - Prefix:DR
Authorized Official - First Name:KHODAYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-428-4300
Mailing Address - Street 1:1930 E COLLEGE WAY
Mailing Address - Street 2:STE. A
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2393
Mailing Address - Country:US
Mailing Address - Phone:360-428-4300
Mailing Address - Fax:360-424-1858
Practice Address - Street 1:1930 E COLLEGE WAY
Practice Address - Street 2:STE. A
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2393
Practice Address - Country:US
Practice Address - Phone:360-428-4300
Practice Address - Fax:360-424-1858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000097191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty