Provider Demographics
NPI:1043806300
Name:SMILE MED
Entity Type:Organization
Organization Name:SMILE MED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:975-905-0864
Mailing Address - Street 1:560 S VALLEY VIEW DR STE 2
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4400
Mailing Address - Country:US
Mailing Address - Phone:975-905-0864
Mailing Address - Fax:214-594-0006
Practice Address - Street 1:560 S VALLEY VIEW DR STE 2
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4400
Practice Address - Country:US
Practice Address - Phone:975-905-0864
Practice Address - Fax:214-594-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty