Provider Demographics
NPI:1538464524
Name:SMASHING SMILES, PLLC
Entity Type:Organization
Organization Name:SMASHING SMILES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLENA
Authorized Official - Middle Name:WILLIS
Authorized Official - Last Name:KENNERLY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:571-278-3680
Mailing Address - Street 1:2021 K ST NW
Mailing Address - Street 2:SUITE 820
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1003
Mailing Address - Country:US
Mailing Address - Phone:202-828-9110
Mailing Address - Fax:202-828-8366
Practice Address - Street 1:2021 K ST NW
Practice Address - Street 2:SUITE 820
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1003
Practice Address - Country:US
Practice Address - Phone:202-828-9110
Practice Address - Fax:202-828-8366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN100004841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty