Provider Demographics
NPI:1518078716
Name:SMILE FACTORY INC
Entity Type:Organization
Organization Name:SMILE FACTORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SPERATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-298-5155
Mailing Address - Street 1:20 BRIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:NY
Mailing Address - Zip Code:13142
Mailing Address - Country:US
Mailing Address - Phone:315-298-5155
Mailing Address - Fax:
Practice Address - Street 1:20 BRIDGE STREET
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:NY
Practice Address - Zip Code:13142
Practice Address - Country:US
Practice Address - Phone:315-298-5155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026370122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty