Provider Demographics
NPI:1528212834
Name:SMILEWRIGHT FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:SMILEWRIGHT FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:IADEROSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-332-0366
Mailing Address - Street 1:303 CONTINENTAL DR
Mailing Address - Street 2:P.O. BOX 948
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-2509
Mailing Address - Country:US
Mailing Address - Phone:330-332-0366
Mailing Address - Fax:
Practice Address - Street 1:303 CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2509
Practice Address - Country:US
Practice Address - Phone:330-332-0366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH191251223G0001X
OH154841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty