Provider Demographics
NPI:1083383749
Name:SENSATIONAL SMILES DENTISTRY SUBSIDIARY
Entity Type:Organization
Organization Name:SENSATIONAL SMILES DENTISTRY SUBSIDIARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-332-4751
Mailing Address - Street 1:6301 S MINNESOTA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2529
Mailing Address - Country:US
Mailing Address - Phone:605-332-4751
Mailing Address - Fax:
Practice Address - Street 1:101 W 37TH ST STE 110
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-5733
Practice Address - Country:US
Practice Address - Phone:605-339-3222
Practice Address - Fax:605-339-7031
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENSATIONAL SMILES DENTISTRY PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental