Provider Demographics
NPI:1568108496
Name:WHITE SPRUCE SMILES DENTAL, PLLC
Entity Type:Organization
Organization Name:WHITE SPRUCE SMILES DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-196-6245
Mailing Address - Street 1:329 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-2118
Mailing Address - Country:US
Mailing Address - Phone:585-919-6624
Mailing Address - Fax:
Practice Address - Street 1:370 WHITE SPRUCE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1604
Practice Address - Country:US
Practice Address - Phone:585-424-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty