Provider Demographics
NPI:1376252478
Name:SMILE CENTER OF SHERIDAN, PLLC
Entity Type:Organization
Organization Name:SMILE CENTER OF SHERIDAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-520-9854
Mailing Address - Street 1:1409 S ROCK ST STE B
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-7180
Mailing Address - Country:US
Mailing Address - Phone:870-942-2020
Mailing Address - Fax:
Practice Address - Street 1:1409 S ROCK ST STE B
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-7180
Practice Address - Country:US
Practice Address - Phone:870-942-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty