Provider Demographics
NPI:1164999181
Name:SMBA DENTISTRY, PLLC
Entity Type:Organization
Organization Name:SMBA DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIVANGI
Authorized Official - Middle Name:B
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:804-272-9079
Mailing Address - Street 1:2801 MCRAE RD STE C1
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3056
Mailing Address - Country:US
Mailing Address - Phone:804-272-9079
Mailing Address - Fax:804-272-9107
Practice Address - Street 1:2801 MCRAE RD STE C1
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-3056
Practice Address - Country:US
Practice Address - Phone:804-272-9079
Practice Address - Fax:804-272-9107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty