Provider Demographics
NPI:1326802190
Name:EXETER SMILES, LLC
Entity Type:Organization
Organization Name:EXETER SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:FIZZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-401-0559
Mailing Address - Street 1:3611 PERKIOMEN AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-2712
Mailing Address - Country:US
Mailing Address - Phone:610-401-0559
Mailing Address - Fax:
Practice Address - Street 1:3611 PERKIOMEN AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-2712
Practice Address - Country:US
Practice Address - Phone:610-401-0559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-12
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty