Provider Demographics
NPI:1184009839
Name:CENTER FOR SMILE DESIGN, LTD
Entity Type:Organization
Organization Name:CENTER FOR SMILE DESIGN, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-746-1481
Mailing Address - Street 1:117 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-3450
Mailing Address - Country:US
Mailing Address - Phone:701-746-1481
Mailing Address - Fax:701-746-6201
Practice Address - Street 1:117 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-3450
Practice Address - Country:US
Practice Address - Phone:701-746-1481
Practice Address - Fax:701-746-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1635261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1635OtherBLUE CROSS BLUE SHIELD OF ND
ND41259Medicaid
000719850OtherUNITED CONCORDIA
1635OtherDELTA DENTAL