Provider Demographics
NPI:1558669127
Name:SMILEMORE UTAH
Entity Type:Organization
Organization Name:SMILEMORE UTAH
Other - Org Name:FAMILY SELECT DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYSON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LEMONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-364-0044
Mailing Address - Street 1:8954 SPANISH RIDGE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1353
Mailing Address - Country:US
Mailing Address - Phone:702-364-0044
Mailing Address - Fax:702-364-0022
Practice Address - Street 1:321 N MALL DR
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7302
Practice Address - Country:US
Practice Address - Phone:949-667-3959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5733266-9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty