Provider Demographics
NPI:1164135240
Name:GOING THE EXTRA SMILE LLC
Entity Type:Organization
Organization Name:GOING THE EXTRA SMILE LLC
Other - Org Name:ANTHEM DENTAL IMPLANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PARMINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:ATWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-372-5973
Mailing Address - Street 1:222 KAREN AVE UNIT 2104
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-5304
Mailing Address - Country:US
Mailing Address - Phone:702-372-5973
Mailing Address - Fax:
Practice Address - Street 1:10880 S EASTERN AVE STE 101
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5706
Practice Address - Country:US
Practice Address - Phone:702-616-1600
Practice Address - Fax:702-616-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty