Provider Demographics
NPI:1144609702
Name:SHENANDOAH SMILES PC
Entity Type:Organization
Organization Name:SHENANDOAH SMILES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-533-6369
Mailing Address - Street 1:519 W JUBAL EARLY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6517
Mailing Address - Country:US
Mailing Address - Phone:540-533-6369
Mailing Address - Fax:
Practice Address - Street 1:519 W JUBAL EARLY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6517
Practice Address - Country:US
Practice Address - Phone:540-533-6369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411741122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty