Provider Demographics
NPI:1346091444
Name:SOPHISTICATED SMILES TC, LLC
Entity Type:Organization
Organization Name:SOPHISTICATED SMILES TC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SCOT
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-307-8726
Mailing Address - Street 1:189 CORPORATE DR STE 20
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2385
Mailing Address - Country:US
Mailing Address - Phone:770-307-8726
Mailing Address - Fax:
Practice Address - Street 1:189 CORPORATE DR STE 20
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2385
Practice Address - Country:US
Practice Address - Phone:770-307-8726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental