Provider Demographics
NPI:1245745686
Name:SMILES FOR A LIFETIME, PA
Entity Type:Organization
Organization Name:SMILES FOR A LIFETIME, PA
Other - Org Name:DOWNTOWN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIKES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-592-0597
Mailing Address - Street 1:117 E HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4509
Mailing Address - Country:US
Mailing Address - Phone:281-592-0597
Mailing Address - Fax:281-592-4351
Practice Address - Street 1:117 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4509
Practice Address - Country:US
Practice Address - Phone:281-592-0597
Practice Address - Fax:281-592-4351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty