Provider Demographics
NPI:1194219139
Name:SMILE STUDIO SPECIALIST INC
Entity Type:Organization
Organization Name:SMILE STUDIO SPECIALIST INC
Other - Org Name:SMILE STUDIO DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELI
Authorized Official - Middle Name:
Authorized Official - Last Name:JANABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-665-5555
Mailing Address - Street 1:7787 LEESBURG PIKE # 200
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-2412
Mailing Address - Country:US
Mailing Address - Phone:703-982-2222
Mailing Address - Fax:703-982-2223
Practice Address - Street 1:7787 LEESBURG PIKE # 200
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2412
Practice Address - Country:US
Practice Address - Phone:703-982-2222
Practice Address - Fax:703-982-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X, 1223D0004X, 1223P0106X, 1223P0300X, 1223P0700X, 1223S0112X, 1223P0106X
VA04014153271223E0200X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Multi-Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty