Provider Demographics
NPI:1407146111
Name:SMILES TODAY DENTAL GROUP, LLC
Entity Type:Organization
Organization Name:SMILES TODAY DENTAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KERIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-655-6777
Mailing Address - Street 1:1580 E DESERT INN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-2548
Mailing Address - Country:US
Mailing Address - Phone:702-655-6777
Mailing Address - Fax:702-547-3522
Practice Address - Street 1:1580 E DESERT INN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2548
Practice Address - Country:US
Practice Address - Phone:702-655-6777
Practice Address - Fax:702-547-3522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4647122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100513096Medicaid