Provider Demographics
NPI:1538327929
Name:SMILES U PEDIATRIC DENTISTRY, PA
Entity Type:Organization
Organization Name:SMILES U PEDIATRIC DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADCLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-803-5154
Mailing Address - Street 1:640 S COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-3409
Mailing Address - Country:US
Mailing Address - Phone:303-803-5154
Mailing Address - Fax:
Practice Address - Street 1:696 HIGHWAY 71 W
Practice Address - Street 2:BUILDING 4, UNIT D
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-4009
Practice Address - Country:US
Practice Address - Phone:303-803-5154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty