Provider Demographics
NPI:1558025056
Name:LEJLA STREETS DMD PLLC
Entity Type:Organization
Organization Name:LEJLA STREETS DMD PLLC
Other - Org Name:SMILES IN THE PINES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEJLA
Authorized Official - Middle Name:
Authorized Official - Last Name:STREETS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-797-0006
Mailing Address - Street 1:7 VILLIAGE CLUB CT STE 200
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8554
Mailing Address - Country:US
Mailing Address - Phone:617-797-0006
Mailing Address - Fax:
Practice Address - Street 1:7 VILLIAGE CLUB CT STE 200
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8554
Practice Address - Country:US
Practice Address - Phone:910-420-2922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-30
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty