Provider Demographics
NPI:1164038774
Name:SUPERIOR SMILES INCORPORATED
Entity Type:Organization
Organization Name:SUPERIOR SMILES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RICHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-629-0942
Mailing Address - Street 1:5640 WASATCH DR STE E
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4993
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5640 WASATCH DR STE E
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4993
Practice Address - Country:US
Practice Address - Phone:801-682-0017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty