Provider Demographics
NPI:1093306565
Name:SMILES OHIO STUART L DUCHON DMD MS LLC
Entity Type:Organization
Organization Name:SMILES OHIO STUART L DUCHON DMD MS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCHON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MS
Authorized Official - Phone:440-799-0030
Mailing Address - Street 1:8 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2819
Mailing Address - Country:US
Mailing Address - Phone:440-799-0030
Mailing Address - Fax:
Practice Address - Street 1:8 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2819
Practice Address - Country:US
Practice Address - Phone:440-799-0030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty