Provider Demographics
NPI:1376257212
Name:THE SMILIST DENTAL PA, PLLC
Entity Type:Organization
Organization Name:THE SMILIST DENTAL PA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP REVENUE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:SAUNDRA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-965-3304
Mailing Address - Street 1:2117 BLUE AZALEA
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-1592
Mailing Address - Country:US
Mailing Address - Phone:562-965-3304
Mailing Address - Fax:
Practice Address - Street 1:40 CUTTERMILL RD STE 500
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3213
Practice Address - Country:US
Practice Address - Phone:562-965-3304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty