Provider Demographics
NPI:1437838828
Name:DUBLIN SMILE SHACK INC
Entity Type:Organization
Organization Name:DUBLIN SMILE SHACK INC
Other - Org Name:SMILE DUBLIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:SUPREETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEERESH
Authorized Official - Suffix:
Authorized Official - Credentials:SV
Authorized Official - Phone:614-588-0491
Mailing Address - Street 1:365 W BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2124
Mailing Address - Country:US
Mailing Address - Phone:614-588-0491
Mailing Address - Fax:
Practice Address - Street 1:365 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2124
Practice Address - Country:US
Practice Address - Phone:614-588-0491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty